JSLS, Journal of the Society of Laparoscopic and Robotic Surgeons

Does laparoscopic adhesiolysis has Risks of recurrence and  Feasibility for small

bowel obstruction
--Manuscript Draft--

Manuscript Number:

Full Title: Does laparoscopic adhesiolysis has Risks of recurrence and  Feasibility for small
bowel obstruction

Article Type: Review Article

Keywords: Acute small bowel obstruction (ASBO), laparoscopic adhesiolysis (LA), Open
adhesiolysis (OA)

Manuscript Classifications: General Surgery

Corresponding Author: Dr.Inamullah furqan, MBBS,FCPS

Hamad General Hospital
DOHA, --None-- QATAR

Corresponding Author E-Mail: inam_jpmc@yahoo.com

Additional Information:

Question Response

Author Comments: please process this paper as earlier as possible. i need publications

Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation
Author Info: All Authors' Names (in Byline Order and Spelling),
Contact Info, and Affiliations

Author’s affiliations, Degrees, and Contact details

1. INAMULLAH
MBBS. FCPS, MRCS
DEPARTMENT OF ACUTE CARE SURGERY, HAMAD MEDICAL CORPORATION DOHA QATAR.
Inam_jpmc@yahoo.com (corresponding author)

2. SYED MUHAMMAD ALI

MBBS, FCPS, FRCS
DEPARTMENT OF ACUTE CARE SURGERY, HAMAD MEDICAL CORPORATION DOHA QATAR.
Alismc2051@gmail.com
Manuscript (including Title Page,  Abstract, References, Figure
Legends, Tables) Do not include author names

Laparoscopic adhesiolysis and the risk of recurrence in adhesive small bowel

1 obstruction, which patients benefit most from laparoscopic approach.
2
3 Inamullah Furqan1, Syed Muhammad Ali2
4
5
6
7 Author’s affiliations, Degrees, and Contact details
8 1. INAMULLAH
9 MBBS. FCPS, MRCS
10 DEPARTMENT OF ACUTE CARE SURGERY, HAMAD MEDICAL CORPORATION DOHA QATAR.
11 Inam_jpmc@yahoo.com (corresponding author)
12
13
2. SYED MUHAMMAD ALI
14
15 MBBS, FCPS, FRCS
16 DEPARTMENT OF ACUTE CARE SURGERY, HAMAD MEDICAL CORPORATION DOHA QATAR.
17 Alismc2051@gmail.com
18
19
20
21 Abstract
22 One of common causes of small bowel obstruction is adhesions and laparoscopic
23
24
adhesiolysis (LA) is gaining popularity as compared to conventional open explorations.
25 Some cases of laparoscopic adhesiolysis(LA) can successfully be managed by
26 conservative/non-operative measures like nil by mouth and ingesting water soluble
27
contrast, but many would ultimately require operative treatment.
28
29 It is estimated that 46% of the patients with open adhesiolysis may end up with further
30 episodes of small bowel obstruction in future. On the other hand, earlier laparoscopic
31 exploration was thought to be contraindicated in cases of adhesive intestinal
32
33 obstruction, however, recent evidence has clearly shown the safety and effectiveness of
34 minimally invasive surgery. Major advantages such as less pain after surgery, reduce
35 hospital stay and less post-operative analgesic need, early recovery, faster small bowel
36
37 motility and function, decreased morbidity and most importantly lesser chances of
38 further adhesion formation, thus, less recurrence rates of ASBO.
39 We searched the literature to determine whether laparoscopic adhesiolysis decreases
40
41 the risk of recurrence in patients with small bowel obstruction or not and to see which
42 patients are suitable for LA.
43
44
45 Key Words
46
47 Acute small bowel obstruction (ASBO), laparoscopic adhesiolysis (LA), Open
48 adhesiolysis (OA)
49
50
51
52 Introduction:
53
54 Among the commonest causes of small bowel obstruction, adhesions after the abdominal
55 surgery is of prime importance and laparoscopic adhesiolysis (LA) is gaining popularity as
56 compared to conventional open explorations. Some cases of adhesive small bowel obstruction
57
58 (ASBO) can successfully be managed by conservative/non-operative measures like nil by
59 mouth and ingesting water soluble contrast, but many would ultimately require operative
60 treatment [1].
61
62
63
64
65
 Laparotomy and open adhesiolysis is the traditional way used for a long time. However more
1 adhesions result after open procedures and it has been estimated that 46% of the patients with
2
3 open adhesiolysis may end up with further episodes of small bowel obstruction in future [2].
4 On the other hand, laparoscopy can look up the adhesions that would not have been mentioned
5 by imaging studies. Thus, laparoscopic adhesiolysis is advantageous and has become well
6
7
recognised and extensive literature is widely available [3,4,5].
8
9 Earlier, laparoscopic exploration was thought to be contraindicated in cases of adhesive
10 intestinal obstruction, however, recent evidence has clearly shown the safety and effectiveness
11 of minimally invasive surgery. Major advantages such as less pain after surgery, reduce
12
13
hospital stay and less post-operative analgesic need, early recovery, faster small bowel motility
14 and function, decreased morbidity and most importantly lesser chances of further adhesion
15 formation, thus, less recurrence rates of ASBO [6,7,8].
16
17 We searched the literature to determine whether laparoscopic adhesiolysis decreases the risk
18
19
of recurrence in patients with small bowel obstruction or not and to see which patients are
20 suitable for LA.
21
22 Patient preparation:
23
24 The preparation of the patients is same as for open surgery including electrolyte and acid base
25 correction, adequate fluid resuscitation and placement of Foley catheter to monitor the fluid
26
response. Intravenous antibiotics are usually given at the anaesthesia induction or started earlier
27
28 if there is an indication. The nasogastric tube should be inserted to decompress the stomach
29 contents and reduce the risk of aspiration. The potential for the risk for bowel injury, and
30 possibility of conversion to open procedure should always be described while the informed
31
32 consent is being taken.
33
34 Access to abdominal cavity and insufflation:
35
36 The placement of first laparoscopic trocar and establishment of pneumoperitoneum is of utmost
37 importance owing to the presence of multiple surgical scars in the abdomen and it must be
38 carried out with extreme precautions. Ideally the entry of first trocar should at least be 5-10
39 cms away from any scar. In cases of previous midline scar left upper quadrant (Palmar point)
40
41
may be a safer point of entry. The Hasson (open) technique is favoured as it is distinctively a
42 better method to gain approach to the abdominal cavity, particularly when dilated bowel or
43 adhesions are anticipated [9]. However, blind access by Veress needle has been reported in a
44 small series of 16 patients by Sato et al without any complications [10]. Blind Veress needle
45 entry had been associated with higher rates of intestinal and vascular injuries even in patients
46
47 without any prior abdominal surgery as shown in many other publications, stressing the safety
48 of open technique entry [11,12,13]. A safer method of close entry can be utilised by
49 ultrasound‐ guidance[14].
50
51
52 Placement of trocars:
53
54 After the insertion of first trocar and pneumoperitoneum and if the space is sufficient for
55 visualisation additional 5 mm ports can be inserted. Usually, 3-4 ports are needed to carry on
56
the whole procedure but additional may be placed if and when required. The principles of
57
58 triangulation of the laparoscopic instruments should be kept in mind to facilitate the procedure.
59
60 Intraoperative findings:
61
62
63
64
65
 Many factors contribute and determine the risk of conversion intraoperatively. Early
1 recognition is of prime importance to decide for conversion and reduce operating time and
2 morbidity. Table 1 outlines some of important operative findings and table 2 shows reasons of
3
4 conversion in some studies.
5
6 Table 1 Operative findings in selected studies
7
8
9
10
11 Isolated band [11,15] 30-60%
12
13 Adhesions + more than one band [15] 31-43%
14
15
16
Internal hernia or peritoneal pouch [11,15] 2-8%
17
18 Adhesions + stricture [11,15,16] 45
19
20 Malignancy [11,12,15] 0-3.6%
21
22 Other (Meckel’s, intussusception, ch. appendicitis etc.)[11,16] 5%
23
24
25
26
27
28
29
30 Nordin et al divided the conversion into reactive ones secondary to intraoperative
31 complications (77%) and remaining preemptive conversions (23%) because of inadequate
32 working space or tough adhesions [17]. In a study of 78 patients by Yao et al, 7 patients were
33 converted to open from laparoscopic approach. Six patients had dense/matted adhesions only
34
35 one was converted because of narrow working space after pneumoperitoneum [18].
36 Other etiologies can be found when exploring for ASBO like internal hernia, intussusception,
37 inguinal hernia, inflammatory bowel disease, neoplasm, and gallstone ileus. One should be
38 wary to deal with these unusual causes as many would end up in conversion to either a
39
40
conventional or mini-laparotomy.
41
42
43
44
45
46 Table 2 Reasons for conversion in selected studies
47
48 Inadequate visibility/ access [11,12,18] 20%–49%
49
50
51 Bowel necrosis or perforation [11,12,17] 19%–23%
52
53 Neoplasm or suspicion of neoplasm [11,12,17] 3%–25%
54
55
Iatrogenic perforation [11,12,17] 14%–19%
56
57 14%–50%
58 Dense/matted adhesions [11,17,18]
59
60
61
62
63
64
65
 Technical difficulties [11,17] 6%
1
2 6.7%
3
Others [17]
4
5
6
7 Dissection of adhesions:
8
9 Adhesions to the abdominal wall should be dealt first with sharp dissection by identifying the
10 bloodless plane seen as white line where the peritoneum of the abdominal wall meets the
11
12 adhesions. It is better to avoid energy sources as the heat can be transmitted to adjacent bowel
13 resulting in thermal damage and perforation later on. Care must be taken to use the cautery to
14 avoid any inadvertent damage to the intestine, thus preferring the blunt and sharp dissection
15 under direct vision.
16
Transection of a single obstructive band separating the proximally dilated and distally
17
18 collapsed bowel permits the free passage of intestinal content usually resolves the obstruction
19 in cases of single adhesive band. However, this may not be the case in most of the patients and
20 in those a gradual laparoscopic exploration of the empty intestine backward from the ileocecal
21
22 valve toward the ligament of Treitz is carried out, until a reason of obstruction is seen[19].
23 Lysis of all visible adhesions should be done and in cases where there still remains a doubt
24 regarding the point of obstruction, it should be converted to open surgery to deal with
25
26 remaining adhesions. Sometimes adjusting the camera angle can help to make the anatomy
27 clear and same goes true for putting extra trocars to manipulate the intestine with proper
28 accessibility. As facial closure of 5 mm port is not necessary so employing extra ports do not
29
30 result in delaying the procedure, possibility of incisional hernia and probably less morbidity if
31 it can avoid the conversion into laparotomy. It is imperative to run the whole bowel twice not
32 to miss any enterotomies or serosal tears that can be managed by sutures or clips and the minor
33
34
bleeding by prudent cautery. Furthermore, mini laparotomy can be performed in any doubtful
35 condition for direct visualisation of the bowel.
36
37
38
39
40
41
42
43
44 Discussion:
45
46 who would benefit most at laparoscopic approach:
47
48 There are many beneficial effects of laparoscopic adhesiolysis but successful results can be
49
50
achieved by proper selection of the patients and astute clinical acumen. What should be the
51 selection criteria, it is still debatable. The recommendations from a panel of experts in a recent
52 conference showed that the conditions that are contraindicated for the establishment of
53
pneumoperitoneum like hemodynamic instability or cardiopulmonary impairment should be
54
55 the only absolute exclusion criteria for laparoscopic adhesiolysis in SBO [20]. All other
56 contraindications are relative and should be assessed on a case-to-case basis, considering the
57 surgeon’s laparoscopic skills. There are no established guidelines that disclose which patients
58
59 will be suited for laparoscopic adhesiolysis, however, multiple factors can predict a successful
60
61
62
63
64
65
 outcome. Table 3 shows Predictors for success and contraindications to laparoscopy for small
1 bowel obstruction.
2
3 Patients of SBO without sign and symptoms of peritonitis are considered for laparoscopic
4
5 exploration provided the non-operative treatment in ineffective [21]. Important consideration
6 to taken in account in these patients are diameter of the intestine, extent of the abdominal
7 distension and site of obstruction (ie jejunum or ileum). Plain X-ray of the abdomen can
8
9 determine the diameter of the bowel and Suter et al [11] concluded increased rate of
10 conversions from 55% versus 32%(P 0.02). if the bowel diameter was more than 4 cm. Early
11 intervention by laparoscopy within 24 hours from the onset of symptoms can predict the rate
12
13
of conversion as the bowel is less distended[22,23] and this makes laparoscopic exploration
14 easy. Therefore, if the X-ray is showing a bowel diameter of (> 4 cm) of small bowel many
15 consider it an absolute contraindication for laparoscopy [21,22,24,25]. CT scan can provide
16
additional information about the site of intestinal occlusion by demonstrating the transition
17
18 point and can differentiate complete from incomplete/partial obstruction. More distal and
19 complete the obstruction is more are the chances of intraoperative complications and
20 conversion to open surgery. Another factor that may predict the unsuccessful laparoscopic
21
22 treatment is the failure of abdominal distension to relieve after nasogastric tube insertion[25].
23
24 Certain factors are associated with successful laparoscopic adhesiolysis like ≤ 2 number of
25 previous laparotomies however, it may not necessarily be a predictor of conversion as it
26 depends on the site (midline or paramedian) and type of previous operations, non-median
27
28 previous laparotomy prior upper abdominal incision, adhesions secondary to open
29 appendectomy, institution of early laparoscopic management within 24 hours, no peritoneal
30 signs of peritonitis, transition point outside the pelvis and incomplete intestinal obstruction
31
32 and very importantly experience of the surgeon[11,22,24,26,27,28,29,30,31]. The selection of
33 the patient should be made carefully as laparoscopy might provide some benefits. In the wake
34 of over distended bowel, it may be fraught with increased risk of moribund complications like
35
36 enterotomies and perforations that might be diagnosed after sometime [32,33]. A recent
37 population-based study, found increased incidence of bowel resections from 53.5 versus 43.4%
38 than in open surgery[34]. Another area of difficulty for laparoscopic surgery is the ASBO
39
40
developing in post irradiated abdomen[35]. However, almost 8.7 % of rate of conversion to
41 open surgery is seen in patients with non‐ resolving partial or incomplete obstruction (after a
42 negative Gastrografin® test) and chronic obstructive symptoms[23].
43
44 The Bologna Guidelines suggest the following criteria for the successful management of the
45
46
intestinal obstruction secondary to peritoneal adhesions laparoscopically as adequate
47 surgeon’s experience, at most two previous laparotomies a likely suspicion of a single adhesion
48 band leading to obstruction[1].
49
50 Some of the absolute contraindications to laparoscopic adhesiolysis include small bowel
51
dilatation of >4cm on abdominal X-ray film and signs of frank peritonitis on physical
52
53 examination of the abdomen[11,21,22,24,30,31,36]. Among the relative contraindications
54 following are included >2 previous laparotomies and multiple adhesions [3,11,18,27,46].
55 However, number of previous laparotomies is not definitely a predictor of conversion as the
56
57 site/s and type of previous incision is more important (like median or lateral)[20].Laparoscopic
58 ileocecal resection for Crohn’s obstructive disease is easily carried out by many surgeons in
59 emergency although some regard it as a contraindication[37].
60
61
62
63
64
65
 Some of the patients with fever (38˚C), leucocytosis > 11000 / mm3, signs of peritonitis and
1 intestinal distention may be evaluated laparoscopically, but, early conversion to conventional
2
3 laparotomy where intestinal necrosis or massive adhesions are encountered should be the
4 priority[35,38]. SAGES guidelines also recommend the contraindications of laparoscopic
5 adhesiolysis are distended bowel that resist safe peritoneal entry and adequate working space,
6
7
frank peritonitis needing resection of intestine, unstable patient, and relative contraindication
8 to pneumoperitoneum due to comorbid conditions [29].
9
10 Table 3. Predictors for success and contraindications to laparoscopy for small bowel
11 obstruction
12
13 Predictor of successful laparoscopic Contraindications to laparoscopic
14
15
adhesiolysis adhesiolysis
16
17 Less than two previous abdominal surgeries Massive abdominal distension that
18 Previous upper abdominal incision prevents safe entry into peritoneal space
19
20
21 Appendectomy as only previous surgery Peritonitis with need of bowel resection
22
23 Transition point outside pelvis Hemodynamically unstable patient
24 Bowel dilatation <4cm
25 Inability to tolerate pneumoperitoneum
Partial bowel obstruction
26
27 Expert laparoscopic surgeon due to comorbid diseases
28
29
30
31
32
33
34
Does laparoscopic adhesiolysis decrease the risk of recurrence in small bowel
35 obstruction:
36
37 There are a few studies comparing long-term outcomes between LA and OA. Earlier studies
38 reporting long-term outcomes of laparoscopically treated SBO are listed in Table-4
39
[10,18,39,40,41] most of which were case series except by Mathieu, Yao, and Park JH et al
40
41 [18,39,40].
42
43 Francois et al [41] reported that 32 of 50 patients (64%) treated by laparoscopic adhesiolysis
44 for small bowel obstruction or chronic abdominal pain were asymptomatic at a mean follow-
45 up of two years. In a study by Sato at al [10], the mean follow-up was 61.7 months, 14 patients
46
47 (87.5%) remained asymptomatic, 2(12.5%) had recurrent small bowel obstruction after
48 laparoscopic adhesiolysis, only one of whom required surgery.
49
50
51 Table 4. Previous reports on long-term outcomes for laparoscopic adhesiolysis
52
53 No year Author No of Median Rate of Rate of
54
55 patients follow-up Recurrence % recurrence in
56 period open
57 surgery
58 1 1994 Francois[41] 52 24 11.5 NA
59
60
61
62
63
64
65
 2 2001 Sato [10] 16 61.7 12.5 NA
1
2
3
3 2004 Borzellino[42] 65 48 15.5 NA
4
5 4 2008 Mathieu[39] 62 6.6 1.0 0
6
7 5 2009 Wang[23] 46 46.5 2.2 NA
8
9
10 6 2017 Siyuan[18] 104 47 7.7 0
11
12 7 2020 Jin Hyung[40] 67 36 2 16.7
13
14
15
16
17
18
19 Borzellino et al included 65 patients with a follow-up period of almost 48 months, about 15.4%
20 had symptomatic recurrences [42]. In another study of 62 patients, the recurrence rate was 1%
21
in laparoscopic adhesiolysis, however, the median follow-up was only 5–6 months, which was
22
23 too brief to evaluate its validity [43].
24
25 Three (6.5%) suffered symptoms after the operation in a series of 46 patients; two had
26 recurrent chronic abdominal pain, and two episodes of acute SBO in one. In two patients with
27 persistent chronic abdominal pain incomplete adhesiolysis of extensive dense and matted intra-
28
29 abdominal adhesions, by laparoscopy was the possible explanation whereas other patient
30 developed recurrent episodes of SBO symptoms after laparotomy[23].
31
32 Yao et al. (2017) compared laparoscopic and open matched patients for readmissions and re-
33 operation rates, SBO-related re-operation was higher in laparoscopic than open adhesiolysis.
34
35 The authors suggested that the missed band in laparoscopy may be the cause of recurrent SBO
36 requiring re-operation. The median follow-up period was 47 months (range 0–106) [18].
37
38 A most recent comparative study by Park et al. (2020) showed that LA is a safer and more
39 reasonable method in SBO treatment compared to OA. It can reduce further adhesion
40
formation and decrease ileus-related complications, re-admission and re-operation rates [40].
41
42
43
44
45
46
47 Conclusion:
48
49 Laparoscopic adhesiolysis can be safer than the open approach because there are lower
50
51
complications. It is method of choice by experienced laparoscopic surgeons in selected
52 patients. Although, evidence-based literature on laparoscopic adhesiolysis is scanty because
53 of the absence of randomised controlled trials, we recommend intra-operative selection of
54 patients after exploratory laparoscopy; this approach allows as many patients as possible to
55 benefit from minimally invasive surgery. Indeed, RCTs are desirable and needed to better
56
57 ascertain the advantages of laparoscopic adhesiolysis over the standard open technique in the
58 form of long term out comes and recurrence rate.
59
60
61
62
63
64
65
 REFERENCES:
1
2
3
4 1. Ten Broek RPG, Krielen P, Di Saverio S, et al.: Bologna guidelines for diagnosis and
5 management of adhesive small bowel obstruction (ASBO): 2017 update of the
6 evidence-based guidelines from the world society of emergency surgery ASBO
7
8
working group. World J. Emerg. Surg. 2018, 13:1–13. 10.1186/s13017-018-0185-2
9 2. Pei KY, Asuzu D, Davis KA: Will laparoscopic lysis of adhesions become the
10
11 standard of care? Evaluating trends and outcomes in laparoscopic management of
12 small-bowel obstruction using the American College of Surgeons National Surgical
13 Quality Improvement Project Database. Surg Endosc. 2017, 31:2180–6.
14 10.1007/s00464-016-5216-z
15
16 3. Coe T, Chang D, Surgery JS-TAJ of, 2015 undefined: Small bowel volvulus in the
17 adult populace of the United States: results from a population-based study. Elsevier.
18
19 4. Paajanen P, Fagerström A, Paajanen H: Laparoscopic Adhesiolysis in Chronic
20
21 Abdominal Pain. J Clin Gastroenterol. 2018, 52:e32–6.
22 10.1097/MCG.0000000000000787
23
24 5. Saleh F, Ambrosini L, Jackson T, Okrainec A: Laparoscopic versus open surgical
25 management of small bowel obstruction: An analysis of short-term outcomes. Surg
26 Endosc. 2014, 28:2381–6. 10.1007/s00464-014-3486-x
27
28 6. Patel R, Borad NP, Merchant AM: Comparison of outcomes following laparoscopic
29 and open treatment of emergent small bowel obstruction: an 11-year analysis of ACS
30
31
NSQIP. Surg Endosc. 2018, 32:4900–11. 10.1007/s00464-018-6249-2
32 7. Turcu F, Arnăutu O, (Bucur) CC-C, 2019 undefined: Adhesiolysis-related challenges
33
34 for laparoscopic procedures after ventral hernia repair with intraperitoneal mesh.
35 pdfs.semanticscholar.org.
36
37 8. Kim W, Kim H, Han S, Kim M, surgery WH-… of, 2016 undefined: Decreased
38 morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy
39 for stage I gastric cancer. ingentaconnect.com.
40
41 9. Bailey I, Rhodes M, … NO-B journal of, 1998 undefined: Laparoscopic management
42 of acute small bowel obstruction. ingentaconnect.com.
43
44 10. Sato Y, Ido K, Kumagai M, et al.: Laparoscopic adhesiolysis for recurrent small bowel
45
46
obstruction: Long-term follow-up. Gastrointest Endosc. 2001, 54:476–9.
47 10.1067/mge.2001.117760
48
49 11. Suter M, Zermatten P, Halkic N, Martinet O, Bettschart V: Laparoscopic management
50 of mechanical small bowel obstruction: Are there predictors of success or failure? Surg
51 Endosc. 2000, 14:478–83. 10.1007/s004640000104
52
53 12. Levard H, Boudet MJ, Msika S, et al.: Laparoscopic treatment of acute small bowel
54 obstruction: A multicentre retrospective study. ANZ J Surg. 2001, 71:641–6.
55
10.1046/j.0004-8682.2001.02222.x
56
57 13. Lujan H, Oren A, Plasencia G, … GC-JJ of the, 2006 undefined: Laparoscopic
58
59 management as the initial treatment of acute small bowel obstruction.
60 ncbi.nlm.nih.gov.
61
62
63
64
65
 14. Borzellino G, De G, endoscopy FR-S laparoscopy &, 1998 undefined: Detection of
1 abdominal adhesions in laparoscopic surgery. A controlled study of 130 cases.
2 europepmc.org.
3
4 15. Sallinen V, Di Saverio S, Haukijärvi E, et al.: Laparoscopic versus open adhesiolysis
5
6
for adhesive small bowel obstruction (LASSO): an international, multicentre,
7 randomised, open-label trial. Lancet Gastroenterol Hepatol. 2019, 4:278–86.
8 10.1016/S2468-1253(19)30016-0
9
10 16. Mitra A, Pandya D, Chandak U, Resident J: Study of Laparoscopic Adhesiolysis in
11 Post Operative Adhesive Intestinal Obstruction.
12
13 17. Nordin A, Freedman J: Laparoscopic versus open surgical management of small bowel
14 obstruction: an analysis of clinical outcomes. Surg Endosc. 2016, 30:4454–63.
15
16
10.1007/s00464-016-4776-2
17 18. Yao S, Tanaka E, Matsui Y, Ikeda A, Murakami T, Okumoto T, Harada T: Does
18
19 laparoscopic adhesiolysis decrease the risk of recurrent symptoms in small bowel
20 obstruction? A propensity score-matched analysis. Surg Endosc. 2017, 31:5348–55.
21 10.1007/s00464-017-5615-9
22
23 19. Khaikin M, Schneidereit N, Cera S, et al.: Laparoscopic vs. open surgery for acute
24 adhesive small-bowel obstruction: patientsÕ outcome and cost-effectiveness. Springer.
25 10.1007/s00464-007-9212-1
26
27 20. Vettoretto N, Carrara A, Corradi A, et al.: Laparoscopic adhesiolysis: consensus
28
29 conference guidelines. Color Dis. 2012, 14:e208–15. 10.1111/j.1463-
30 1318.2012.02968.x
31
32 21. Nagle A, Ujiki M, Denham W, Murayama K: Laparoscopic adhesiolysis for small
33 bowel obstruction. Am J Surg. 2004, 187:464–70. 10.1016/j.amjsurg.2003.12.036
34
35 22. Sauerland S, Agresta F, Bergamaschi R, et al.: Laparoscopy for abdominal
36 emergencies: Evidence-based guidelines of the European Association for Endoscopic
37 Surgery. In: Surgical Endoscopy and Other Interventional Techniques. Springer; 2006.
38
39
14–29.10.1007/s00464-005-0564-0
40
23. Wang Q, Hu ZQ, Wang WJ, Zhang J, Wang Y, Ruan CP: Laparoscopic management
41
42 of recurrent adhesive small-bowel obstruction: Long-term follow-up. Surg Today.
43 2009, 39:493–9. 10.1007/s00595-008-3906-4
44
45 24. Borzellino G, Tasselli S, Zerman G, Pedrazzani C, Manzoni G: Laparoscopic approach
46 to postoperative adhesive obstruction. Surg Endosc Other Interv Tech. 2004, 18:686–
47 90. 10.1007/s00464-003-9106-9
48
49 25. Szomstein S, Lo Menzo E, Simpfendorfer C, Zundel N, Rosenthal RJ: Laparoscopic
50 lysis of adhesions. World J Surg. 2006, 30:535–40. 10.1007/s00268-005-7778-0
51
52 26. Farinella E, Cirocchi R, La Mura F, et al.: Feasibility of laparoscopy for small bowel
53
54
obstruction. World J Emerg Surg. 2009, 4:1–9. 10.1186/1749-7922-4-3
55
27. chirurgie JD-J de, 2003 undefined: Post-operative bowel obstruction. Part 1:
56
57 Intraperitoneal bands and adhesions--causes and prevention. europepmc.org.
58
59 28. Slim K: Laparoscopic treatment of small bowel obstructions. Chirurgie. 1999,
60 124:177–81. 10.1016/S0001-4001(99)80062-2
61
62
63
64
65
 29. Kuhnen AH: The Role of Laparoscopy in the Management of Bowel Obstruction. In:
1 The SAGES Manual of Colorectal Surgery. Springer International Publishing; 2020.
2 411–8.10.1007/978-3-030-24812-3_26
3
4 30. Agresta F, Piazza A, Michelet I, Bedin N, Sartori CA: Small bowel obstruction:
5
6
Laparoscopic approach. Surg Endosc. 2000, 14:154–6. 10.1007/s004649900089
7
8
31. Szomstein S, Lo Menzo E, Simpfendorfer C, Zundel N, Rosenthal RJ: Laparoscopic
9 lysis of adhesions. World J Surg. 2006, 30:535–40. 10.1007/s00268-005-7778-0
10
11 32. Strik C, Stommel MWJ, ten Broek RPG, van Goor H: Adhesiolysis in Patients
12 Undergoing a Repeat Median Laparotomy. Dis Colon Rectum. 2015, 58:792–8.
13 10.1097/DCR.0000000000000405
14
15 33. ten Broek RPG, Strik C, van Goor H: Preoperative nomogram to predict risk of bowel
16 injury during adhesiolysis. Br J Surg. 2014, 101:720–7. 10.1002/bjs.9479
17
18 34. Behman R, Nathens AB, Byrne JP, Mason S, Look Hong N, Karanicolas PJ:
19 Laparoscopic Surgery for Adhesive Small Bowel Obstruction Is Associated With a
20
21 Higher Risk of Bowel Injury. Ann Surg. 2017, 266:489–98.
22 10.1097/SLA.0000000000002369
23
24 35. Nakamura T, Ishii Y, Tsutsui A, … MK-SL, 2017 undefined: Safety and indications
25 of laparoscopic surgery for postoperative small-bowel obstruction: a single-center
26 study of 121 patients. journals.lww.com.
27
28 36. Dindo D, Schafer M, Muller MK, Clavien PA, Hahnloser D: Laparoscopy for small
29 bowel obstruction: The reason for conversion matters. Surg Endosc. 2010, 24:792–7.
30
31
10.1007/s00464-009-0658-1
32 37. Basili G, Lorenzetti L, Celona G, et al.: Gallstone ileus in patient with Crohn’s disease:
33
34 Report of a clinical observation. Surg Endosc Other Interv Tech. 2006, 20:703–4.
35 10.1007/s00464-005-0579-6
36
37 38. Bobic S, Constantin VD, Kaya MA, et al.: ICAMS 2018-7 th International Conference
38 on Advanced Materials and Systems POSTOPERATIVE PERITONEAL
39 ADHESIONS PROPHYLAXY USING COLLAGEN-BASED BIOMATERIALS.
40
10.24264/icams-2018.I.5
41
42 39. Mathieu X, Thill V, Simoens C, Smets D, Ngongang C, Debergh N, Mendes Da Costa
43
44 P: Laparoscopic management of acute small bowel obstruction: A retrospective study
45 on 156 patients. Hepatogastroenterology. 2008, 55:522–6.
46
47 40. Park JH, Kim DJ, Park JH: Does Laparoscopic Adhesiolysis Reduce the Risk of Small
48 Bowel Obstruction Related Readmissions and Reoperations Compared to Open
49 Adhesiolysis? J Minim Invasive Surg. 2020, 23:86–92. 10.7602/jmis.2020.23.2.86
50
51 41. Francois Y, Mouret P, Tomaoglu K, Vignal J: Postoperative adhesive peritoneal
52 disease - Laparoscopic treatment. Surg Endosc. 1994, 8:781–3. 10.1007/BF00593440
53
54 42. Borzellino G, Tasselli S, Zerman G, Pedrazzani C, Manzoni G: Laparoscopic approach
55
to postoperative adhesive obstruction. Surg Endosc Other Interv Tech. 2004, 18:686–
56
57 90. 10.1007/s00464-003-9106-9
58
59 43. Mathieu X, Thill V, Simoens C, Smets D, Ngongang C, Debergh N, Mendes Da Costa
60 P: Laparoscopic management of acute small bowel obstruction: A retrospective study
61
62
63
64
65
 on 156 patients. Hepatogastroenterology. 2008, 55:522–6.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
Disclosure of Conflicts of Interest and Financial Support /
Acknowledgments (Refer to authors by Unique Initials or Byline

Click here to access/download

Disclosure of Conflicts of Interest and Financial Support
/ Acknowledgments (Refer to authors by Unique Initials
or Byline Order - Not Name)
disclosure.docx