Numerous studies have demonstrated the feasibility of laparoscopy in the management of acute adhesive small-bowel obstruction.
However, comparative data with laparotomy are lacking.
Dr Wexner and colleagues from Florida compared laparoscopy and laparotomy for the treatment of acute adhesive small-bowel obstruction in terms of patient outcome and cost-effectiveness.
The research team conducted a retrospective chart review of all patients who underwent surgery for acute adhesive small-bowel obstruction from 1999 to 2005.
The team recorded data on operative and postoperative course, among others.
Operative and total hospital charges were estimated from the Patient Accounting System.
|Median time to first bowel movement was shorter in the laparoscopy group|
The researchers matched 31 patients who underwent laparoscope's to a similar group of patients who underwent laparotomy.
In the laparoscopy group, 13% of patients had a laparoscopy-assisted procedure and 32% of patients were converted.
The laparoscopy group was subdivided into laparoscopy, laparoscopy-assisted, converted, and assisted-converted subgroups.
In the majority of the patients, the team observed that acute adhesive small-bowel obstruction was secondary to a single band.
The researchers noted that overall morbidity was significantly higher in the laparotomy group.
The team found that morbidity rates were statistically significant between the laparoscopy and assisted-converted subgroups.
However, morbidity rates were not significantly different between the laparotomy group and assisted-converted subgroup.
The team found that median hospital stay and median time to first bowel movement were significantly shorter in the laparoscopy group.
Charge data were available for only the last 3 years of the study.
The team noted that operative charges and total hospital charges were similar between the laparoscopy and the laparotomy groups.
In addition, the researchers found a significant difference in total hospital charges between the laparoscopy subgroup and laparotomy group.
Dr Wexner's team concluded, "Laparoscopy for acute adhesive small-bowel obstruction is associated with reduced hospital stay, early recovery, and decreased morbidity."
"Laparoscopy-assisted and converted surgeries do not differ significantly from laparotomy in regard to patient outcome."
"Operative and total hospital charges are similar for both laparoscopy and laparotomy."