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Prevalence and Mechanisms of Small Intestinal Obstruction Following Laparoscopic Abdominal Surgery
A Retrospective Multicenter Study
Jean-Jacques Duron, MD;
Jean Marie Hay, MD;
Simon Msika, MD;
Denis Gaschard, MD;
Jacques Domergue, MD;
Alain Gainant, MD;
Abe Fingerhut, MD, FACS, FRCS;
for the French Association for Surgical Research
Arch Surg. 2000;135:208-212.
Hypothesis The prevalence and mechanisms of intestinal obstruction following laparoscopic abdominal surgery have not been studied extensively.
Design Retrospective review of cases of intestinal obstruction after laparoscopic surgery.
Setting Sixteen surgical units performing laparoscopy in France.
Patients Twenty-four patients with intestinal obstruction.
Main Outcome Measures Prevalence values and descriptive data.
Results The 3 most frequent primary procedures responsible for intestinal obstruction were cholecystectomy (10 cases), transperitoneal hernia repair (5 cases), and appendectomy (4 cases). Prevalences of early postoperative intestinal obstruction after these procedures were 0.11%, 2.5%, and 0.16%, respectively. Intestinal obstruction was due to adhesions or fibrotic bands in 12 cases and to intestinal incarceration in 11 cases. Obstruction was located at the trocar site in 13 cases (9 incarcerations and 4 adhesions), mainly at the umbilicus, and in the operative field in 10 cases (2 incarcerations in a wall defect after transperitoneal inguinal hernia repair, 4 adhesions, and 4 fibrotic bands). The small intestine was involved in 23 of 24 cases; the other was due to cecal volvulus following unrecognized intestinal malrotation. Intestinal obstruction was treated by laparoscopic adhesiolysis in 6 patients and by laparotomy in 18 patients, 6 of whom required small intestine resection. Three postoperative complications but no deaths occurred.
Conclusion Intestinal obstruction following laparoscopic abdominal surgery can occur irrespective of the type of operation; the prevalence is as high as (cholecystectomy and appendectomy) or even higher than (transperitoneal hernia repair) that seen in open procedures.
From the Departments of Surgery, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (Dr Duron); Hôpital Louis Mourier, Colombes, France (Drs Hay, Msika, and Gaschard); Hôpital Saint-Eloi, Montpellier, France (Dr Domergue); Hôpital Dupuytren, Limoges, France (Dr Gainant); and Hôpital Léon Touhladjian, Poissy, France (Dr Fingerhut).
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