Laparoscopic adhesiolysis for recurrent postoperative small bowel obstruction.

BACKGROUND/AIMS: Recurrent small bowel obstruction caused by postoperative adhesions has been treated by conventional laparotomy, however laparoscopic management of acute and recurrent small bowel obstruction has been demonstrated. This study assessed the clinical outcome and long-term efficacy of laparoscopic adhesiolysis for recurrent adhesive small bowel obstruction. METHODOLOGY: Elective laparoscopic treatment following conservative management was attempted in 25 patients hospitalized for recurrent small bowel obstruction after abdominal or pelvic surgery. RESULTS: The pathologic sites of postoperative adhesions and adhesive types were identified laparoscopically in all patients. Complete laparoscopic adhesiolysis was feasible in 18 patients (72%), while conversion to laparoscopic-assisted adhesiolysis (mini-laparotomy with an incision less than 4 cm long) was required in 6 patients (24%) because of dense adhesion or the technical difficulties due to adhesion in the pelvic cavity. Conversion to laparotomy was required for one patient because of excessive adhesions and intestinal perforation (4%). Long-term follow-up was possible in all patients. There was no recurrence of small bowel obstruction over a mean follow-up period of 41 months. CONCLUSIONS: Laparoscopic adhesiolysis is a safe and effective treatment for recurrent small bowel obstruction in selected cases. Conversion to mini-laparotomy or laparotomy should be considered in patients with dense or pelvic adhesion.