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Kwok Kay Yau, MB, ChB, FRCS(Edin); Wing Tai Siu, MB, ChB, FRCS(Edin); Bonita Ka Bo Law, MB, ChB, FRCS(Edin); Hester Yui Shan Cheung, MB, ChB, MRCS(Edin); Joe Ping Yiu Ha, MBBS, FRCS(Edin); Michael Ka Wah Li, MBBS, MRCS(Eng), LRCP(Eng), FRCS(Eng), FRCS(Edin)

Arch Surg. 2005;140:972-975.

Background  Bezoar-induced small-bowel obstruction (SBO) is an uncommon surgical emergency. Accurate preoperative diagnosis is notoriously difficult, and conventional management often necessitates laparotomy. Recent articles demonstrate the feasibility of laparoscopy in the management of SBO. This study compares the outcomes of a series of cases managed laparoscopically with the outcomes of matched open cases.

Hypothesis  Laparoscopic management of bezoar-induced SBO is safe and effective when compared with traditional laparotomy treatment.

Patients and Methods  A retrospective study was conducted from November 1, 1998, to November 30, 2003, to compare laparoscopic vs open treatment for bezoar-induced SBO. Patients’ demographics, operative details, and surgical outcomes were evaluated.

Results  During the study period, 24 patients (16 men and 8 women) with a mean age of 68.2 years underwent operative treatments for bezoar-induced SBO. Ten patients received laparoscopic treatments and the other 14 received laparotomy treatments. The patients were comparable in age, sex, and physiological status. There were 3 conversions in the laparoscopy group owing to technical difficulties. The laparoscopic approach was associated with statistically significant shorter operative time (P = .048), fewer postoperative complications (P = .04), and reduced hospital stay (P = .009).

Conclusions  When expertise is available, laparoscopy is safe and effective in the management of bezoar-induced SBO and is associated with superior postoperative outcomes when compared with the conventional open approach.

Author Affiliations: Department of Surgery, Pamela Youde Nethersole Eastern Hospital (Drs Yau, Cheung, Ha, and Li), and Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital (Drs Siu and Law), Hong Kong.

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