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News

Laparoscopic lysis of adhesions for intestinal obstruction in the USA

The latest issue of the Journal of the American College of Surgeons examines the nationwide impact of laparoscopic lysis of adhesions in the management of intestinal obstruction in the USA.

News image

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Treatment of adhesion-related complications is cost intensive and presents a considerable burden to the health care system.

Dr Gregory Mancini and colleagues from Tennessee, USA compared open and laparoscopic lysis of adhesions in the treatment of intestinal obstruction, based on a nationwide representative sample.

Patients with intestinal obstruction undergoing open and laparoscopic lysis of adhesions and conversion were identified from the 2002 National Inpatient Sample.

Conversion was required in 17% of laparoscopic lysis of adhesions patients
Journal of hte American College of Surgeons

Propensity methods were used to adjust for covariates including patient demographics, hospital characteristics, and comorbidities.

The impact of open and laparoscopic lysis of adhesions was analyzed concerning in-hospital mortality, postoperative complications, length of stay, and in-hospital costs.

Of 6165 patients, 89% underwent open lysis of adhesions and 11% had laparoscopic lysis of adhesions.

Conversion was required in 17% of laparoscopic lysis of adhesions patients.

Unadjusted mortality was equal between laparoscopic lysis of adhesions and conversion, and half the rate compared with open lysis of adhesions.

After adjusting with propensity methods, the odds of complications in the laparoscopic lysis of adhesions group were 25% less than in the open laparoscopic lysis of adhesions.

The team noted that the laparoscopic lysis of adhesions group had a 27% shorter length of stay, and was 9% less expensive than the open laparoscopic lysis of adhesions group.

The research team found no statistical significant difference for length of stay, complications, and costs between the conversion and open laparoscopic lysis of adhesions.

Dr Mancini’s team concluded, “Results from this study suggest that when laparoscopic lysis of adhesions is applied to selected patients with intestinal obstruction, there are reductions in postoperative complications, length of stay, and costs.”

“Prospective studies are needed to confirm these data and better identify the subgroup of patients who have improved outcomes with laparoscopic lysis of adhesions.”

J Am Coll Surg 2008: 207(4): 520-6


02 October 2008

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