J Curr Surg

Journal of Current Surgery, ISSN 1927-1298 print, 1927-1301 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Curr Surg and Elmer Press Inc

Journal website https://www.currentsurgery.org

Original Article

Volume 11, Number 1, March 2021, pages 1-7

Laparoscopic Management for Small Bowel Obstruction: Experience From a UK District General Hospital With One-Year Follow-Up

**Table 1.** Demographics of Patients
SBO (N = 99)	Laparoscopic (N = 31)	Open (laparotomy) (N = 68)	P value
SBO: small bowel obstruction; TLA: totally laparoscopic approach; LAG: laparoscopic-assisted group; A&E: accident and emergency department; GP: general practitioners.
Age (years)	71 (23 - 94)	69 (26 - 91)
Charlson comorbidity index (median)	TLA: 3 (0 - 12) LAG: 5 (2 - 11) All laparoscopic data: 6 (0 - 12)	6 (2 - 12)	0.016 0.13 0.23
Route of referral	A&E: 24 Others: 5 GP: 2	A&E: 60 Others: 6 GP: 2
History of prior abdominal surgery	LAG: 14/16 (87%) TLA: 6/15 (40%)	35/68 (51%)

Table 1. Demographics of Patients

SBO (N = 99)

Laparoscopic (N = 31)

Open (laparotomy) (N = 68)

P value

SBO: small bowel obstruction; TLA: totally laparoscopic approach; LAG: laparoscopic-assisted group; A&E: accident and emergency department; GP: general practitioners.

Age (years)

71 (23 - 94)

69 (26 - 91)

Charlson comorbidity index (median)

TLA: 3 (0 - 12)
LAG: 5 (2 - 11)
All laparoscopic data: 6 (0 - 12)

6 (2 - 12)

0.016
0.13
0.23

Route of referral

A&E: 24
Others: 5
GP: 2

A&E: 60
Others: 6
GP: 2

History of prior abdominal surgery

LAG: 14/16 (87%)
TLA: 6/15 (40%)

35/68 (51%)

**Table 2.** Preoperative Characteristics
SBO (N = 99)	Laparoscopic (N = 31)	Open (laparotomy) (N = 68)	P value (Mann-Whitney U test)
SBO: small bowel obstruction; CRP: C-reactive protein; WBC: white blood cell count; TLA: totally laparoscopic approach; LAG: laparoscopic-assisted group.
CRP	TLA: 8 (1 - 34) LAG: 13.5 (1 - 212) All laparoscopic data: 8 (1 - 212)	21.5 (1 - 433)	0.03 0.05 0.05
WBC	TLA: 9 (5 - 26) LAG: 9 (4 - 22) All laparoscopic data: 9 (4 - 26)	10.5 (4.4 - 29.9)	0.32 0.06 0.09
Time to operation from admission (days)	TLA only: 1 (0.5 - 1.0) LAG: 1.5 (0.5 - 9) All laparoscopic data: 1 (0.5 - 9)	1 (0.5 - 15) Mean: 2.55 days	0.005 0.27 0.21

Table 2. Preoperative Characteristics

SBO (N = 99)

Laparoscopic (N = 31)

Open (laparotomy) (N = 68)

P value (Mann-Whitney U test)

SBO: small bowel obstruction; CRP: C-reactive protein; WBC: white blood cell count; TLA: totally laparoscopic approach; LAG: laparoscopic-assisted group.

CRP

TLA: 8 (1 - 34)
LAG: 13.5 (1 - 212)
All laparoscopic data: 8 (1 - 212)

21.5 (1 - 433)

0.03
0.05
0.05

WBC

TLA: 9 (5 - 26)
LAG: 9 (4 - 22)
All laparoscopic data: 9 (4 - 26)

10.5 (4.4 - 29.9)

0.32
0.06
0.09

Time to operation from admission (days)

TLA only: 1 (0.5 - 1.0)
LAG: 1.5 (0.5 - 9)
All laparoscopic data: 1 (0.5 - 9)

1 (0.5 - 15)
Mean: 2.55 days

0.005
0.27
0.21

**Table 3.** Causes of SBO Confirmed Intraoperatively
Laparoscopic surgery group (N = 31)	Laparotomy group (N = 68)
SBO: small bowel obstruction; TLA: totally laparoscopic approach; LAG: laparoscopic-assisted group.
TLA: 10 single band adhesion, 2 multiple adhesions, 3 others (hernias/foreign body) LAG: 2 single band adhesion, 11 multiple adhesions, 3 others (hernias, small bowel lymphoma)	Single band adhesion: 34 Multiple adhesions: 21 Others (tumors/ischemia/hernias): 13

Table 3. Causes of SBO Confirmed Intraoperatively

Laparoscopic surgery group (N = 31)

Laparotomy group (N = 68)

SBO: small bowel obstruction; TLA: totally laparoscopic approach; LAG: laparoscopic-assisted group.

TLA: 10 single band adhesion, 2 multiple adhesions, 3 others (hernias/foreign body)
LAG: 2 single band adhesion, 11 multiple adhesions, 3 others (hernias, small bowel lymphoma)

Single band adhesion: 34
Multiple adhesions: 21
Others (tumors/ischemia/hernias): 13

**Table 4.** Single Band Adhesion: Sub-Group Analysis
SBO (N = 48)	Laparoscopic (N = 12)	Open (laparotomy) (N = 34)	P value (Mann-Whitney U test)
SBO: small bowel obstruction; HDU: high dependency unit; ITU: intensive therapy unit; AKI: acute kidney injury.
Age (years)	69.5 (35 - 90)	75 (46 - 89)	0.37
Charlson comorbidity index (median)	3 (2 - 12)	5.5 (2 - 11)	0.16
History of prior abdominal surgery	4/12 (33%)	17/34 (50%)	0.40
Small bowel resection rate	None	10	0.06
HDU/ITU care	2 (16.6%)	10 (29.4%)	0.52
Complication AKI	3 (25%)	9 (26%)	0.83
Overall complication rate	4 (33%)	10 (29%)	0.84
Length of hospital stay (median days)	6.5 (2 - 28)	10 (3 - 31)	0.02

Table 4. Single Band Adhesion: Sub-Group Analysis

SBO (N = 48)

Laparoscopic (N = 12)

Open (laparotomy) (N = 34)

P value (Mann-Whitney U test)

SBO: small bowel obstruction; HDU: high dependency unit; ITU: intensive therapy unit; AKI: acute kidney injury.

Age (years)

69.5 (35 - 90)

75 (46 - 89)

0.37

Charlson comorbidity index (median)

3 (2 - 12)

5.5 (2 - 11)

0.16

History of prior abdominal surgery

4/12 (33%)

17/34 (50%)

0.40

Small bowel resection rate

None

0.06

HDU/ITU care

2 (16.6%)

10 (29.4%)

0.52

Complication AKI

3 (25%)

9 (26%)

0.83

Overall complication rate

4 (33%)

10 (29%)

0.84

Length of hospital stay (median days)

6.5 (2 - 28)

10 (3 - 31)

0.02

**Table 5.** Postoperative Characteristics
SBO (N = 99)	Laparoscopic (N = 31)	Open (laparotomy) (N = 68)	P value with Yates’ correction (Chi-squared test)
SBO: small bowel obstruction; HDU: high dependency unit; ITU: intensive therapy unit; TLA: totally laparoscopic approach; LAG: laparoscopic-assisted group; AKI: acute kidney injury.
Small bowel resection rate	5/31 (16%)	27/68 (39%)	0.03
HDU/ITU care	8/31 (25%)	28/68 (41%)	0.21
Complication AKI	6/31 (19%)	19/68 (27.9%)	0.50
Overall complication rate	8/31 (25%) Chest infection: 2 Wound infection: 1	27/68 (39%) Chest infection: 12 Wound infection: 10	0.26
Length of Hospital Stay (Median days)	TLA: 5 (2 - 28) LAG: 11.5 (4 - 19) All lap: 10 (2 - 28)	11 (4 - 140)	0.025 (Mann-Whitney U test) 0.32 0.025
30-day mortality	0/31	4/68	0.12
1-year mortality	1/31	7/68	0.13

Table 5. Postoperative Characteristics

SBO (N = 99)

Laparoscopic (N = 31)

Open (laparotomy) (N = 68)

P value with Yates’ correction (Chi-squared test)

SBO: small bowel obstruction; HDU: high dependency unit; ITU: intensive therapy unit; TLA: totally laparoscopic approach; LAG: laparoscopic-assisted group; AKI: acute kidney injury.

Small bowel resection rate

5/31 (16%)

27/68 (39%)

0.03

HDU/ITU care

8/31 (25%)

28/68 (41%)

0.21

Complication AKI

6/31 (19%)

19/68 (27.9%)

0.50

Overall complication rate

8/31 (25%)
Chest infection: 2
Wound infection: 1

27/68 (39%)
Chest infection: 12
Wound infection: 10

0.26

Length of Hospital Stay (Median days)

TLA: 5 (2 - 28)
LAG: 11.5 (4 - 19)
All lap: 10 (2 - 28)

11 (4 - 140)

0.025 (Mann-Whitney U test)
0.32
0.025

30-day mortality

0/31

4/68

0.12

1-year mortality

1/31

7/68

0.13

**Table 6.** Comparison Between Similar Studies
	Current study (N = 99)	NASBO (2017) [19] (N = 1,168)	Sebastian-Valverde et al, BMC surgery (2019) [20] (N = 262)
TLA: totally laparoscopic approach; LAG: laparoscopic-assisted group.
Age, median and range	Lap: 71 (23 - 94) Open: 69 (26 - 91)	All patients: 71 (18 - 101)	Lap: 59.36 (41 - 78) Open: 68.9 (50 - 87)
TLA	15 (15%)	174 (14%)	48 (18%)
Laparoscopic converted	16 (16%)	172 (14%)	30 (11%)
Open (laparotomy)	68 (68%)	792 (67%)	184 (70%)
Charlson comorbidity index	TLA: 3 (0 - 12) LAG: 5 (2 - 11) All lap: 6 (0 - 12) Open: 6 (2 - 12)		ASA I: 22 ASA II: 97 ASA III: 112 ASA IV: 23
Single band adhesion or internal hernia	TLA: 11/15 LAG: 4/16 Open: 34/68		TLA lap only: 37/48 LAG: 16/30 Open: 76/184
Small bowel resection rate	Lap: 5/31 Open: 27/68 Overall: 32%	Overall: 34%	Overall 21%
Complication rate	Lap: 8/31 (25%) Open: 27/68 (39%)	Overall: 41%	Lap: 9/48 (18.7%) Open: 25/30 (83.3%)
Length of hospital stay	TLA: 5 (2 - 28) LAG: 11.5 (4 - 19) All lap: 10 (2 - 28) Open: 11 (4 - 140)	10.7	TLA: 4 (1 - 7) LAG: 10 (1 - 19) All lap: 5 (1 - 19) Open: 10 (2 - 28)
Readmission rate	Lap 2/31(6%) Open 5/68 (7%)	13%	Lap: 3 (3.8%) Open: 14 (8.4%)
30-day mortality rate	Lap: 0/31 Open: 4/68 (5.8%)	8%	Lap: 1 Open: 16 (8.6%)

Table 6. Comparison Between Similar Studies

Current study (N = 99)

NASBO (2017) [19] (N = 1,168)

Sebastian-Valverde et al, BMC surgery (2019) [20] (N = 262)

TLA: totally laparoscopic approach; LAG: laparoscopic-assisted group.

Age, median and range

Lap: 71 (23 - 94)
Open: 69 (26 - 91)

All patients: 71 (18 - 101)

Lap: 59.36 (41 - 78)
Open: 68.9 (50 - 87)

TLA

15 (15%)

174 (14%)

48 (18%)

Laparoscopic converted

16 (16%)

172 (14%)

30 (11%)

Open (laparotomy)

68 (68%)

792 (67%)

184 (70%)

Charlson comorbidity index

TLA: 3 (0 - 12)
LAG: 5 (2 - 11)
All lap: 6 (0 - 12)
Open: 6 (2 - 12)

ASA I: 22
ASA II: 97
ASA III: 112
ASA IV: 23

Single band adhesion or internal hernia

TLA: 11/15
LAG: 4/16
Open: 34/68

TLA lap only: 37/48
LAG: 16/30
Open: 76/184

Small bowel resection rate

Lap: 5/31
Open: 27/68
Overall: 32%

Overall: 34%

Overall 21%

Complication rate

Lap: 8/31 (25%)
Open: 27/68 (39%)

Overall: 41%

Lap: 9/48 (18.7%)
Open: 25/30 (83.3%)

Length of hospital stay

TLA: 5 (2 - 28)
LAG: 11.5 (4 - 19)
All lap: 10 (2 - 28)
Open: 11 (4 - 140)

10.7

TLA: 4 (1 - 7)
LAG: 10 (1 - 19)
All lap: 5 (1 - 19)
Open: 10 (2 - 28)

Readmission rate

Lap 2/31(6%)
Open 5/68 (7%)

13%

Lap: 3 (3.8%)
Open: 14 (8.4%)

30-day mortality rate

Lap: 0/31
Open: 4/68 (5.8%)

Lap: 1
Open: 16 (8.6%)