Conversion Reduces the Success of Laparoscopic Approach for Adhesive Small Bowel Obstruction. A Propensity-Score Matching Analysis

Abstract

\n Background. Although the use of the laparoscopic approach has increased in recent years, the open approach remains the most widely used for surgical treatment of adhesive small bowel obstruction (ASBO). Moreover, there is no consensus in international guidelines on the role and the usefulness of the laparoscopic approach in ASBO. The aims of this study were to determine the role of the laparoscopic approach in ASBO and to define in which situations it can be beneficial.Methods. We performed a retrospective analysis of a prospectively maintained database of patients who had undergone surgery for ASBO between January 2007 and December 2019. Pre-, intra- and post-operative variables were analysed. Bivariate, logistic regression and a propensity-score matching analyses were performed to compare the laparoscopic and open approach.Results. A total of 333 patients who underwent ASBO surgery were analysed: 224 patients by conventional approach and 109 initially by laparoscopic approach. In the overall analysis, morbidity and mortality were significantly higher in the open group, while the initiation of oral intake and hospital stay were significantly lower in the laparoscopic group. The conversion rate was 36.7%. After propensity-score matching analyses, only the surgeon s laparoscopic skills achieved statistically significant differences between groups in the intention-to treat analysis, but the need for intestinal resection, surgical time, onset of oral intake, hospital stay and morbidity were significantly lower in whom surgery could be completed laparoscopically.Conclusion. The laparoscopic approach is feasible and safe in ASBO, but its advantages are limited to those patients who do not require conversion to open surgery. Both patient selection and the surgeon s expertise in advanced laparoscopic surgery are essential.