Small bowel obstruction caused by adhesions is one of the most common causes of hospital admission among children. Until recently, the presence of symptoms of small bowel obstruction was the contraindication for laparoscopy; however, rapid development of minimally-invasive surgery determined the implementation of these methods in the management of patients with small bowel obstruction.
The objective of the research was to summarize our own experience of laparoscopic treatment of children with small bowel obstruction.
Materials and methods. The study is based on the results of laparoscopic management of 86 children being operated on during 2007-2015. Laparoscopy was used in 90.7% of patients and laparoscopically assisted procedures were performed in 9.3% of cases.
Results. Adhesive small bowel obstruction occurred more often after laparotomy (70.9%), while after laparoscopy it was detected in 16.3% of patients only. During surgical revision of the abdominal cavity, single obstructive bands often in the area of the ileocecal valve were found in 55.8% patients; diffuse dense bands were observed in 31.4% of children; in 12.8% of children twisting of a loop of small bowel around the Meckel’s diverticulum was noted. Laparoscopically assisted procedures were applied in cases that required bowel resection. The postoperative complication rate was 9.3%.
Conclusions. In the presence of appropriate skills, laparoscopic adhesiolysis can be a real alternative to conventional laparotomy in treating children with small bowel obstruction. The usage of remedies with anti-adhesive properties improves the results of treating children with bowel obstruction.
Okabayashi K, Ashrafian H, Zacharakis E, et al. Adhesions after abdominal surgery: a systematic review of the incidence, distribution and severity. Surg Today. 2014;44:405-420. http://doi.org/10.1007/s00595-013-0591-8
Catena F, Di Saverio S, Coccolini F, et al. Adhesive small bowel adhesions obstruction: Evolutions in diagnosis, management and prevention. World J Gastrointest Surg. 2016;8:222-231. http://doi.org/10.4240/wjgs.v8.i3.222
Loftus T, Moore F, Van Zant E, et al. A protocol for the management of adhesive small bowel obstruction. J Trauma Acute Care Surg. 2015;78:13-21. http://doi.org/10.1097/TA.0000000000000491
ten Broek RPG, Stommel MWJ, Strik C, et al. Benefits and harms of adhesion barriers for abdominal surgery: a systematic review and meta-analysis. Lancet. 2014;383:48-59. http://doi.org/10.1016/S0140-6736(13)61687-6
Goussous N, Kemp KM, Bannon MP, et al. Early postoperative small bowel obstruction: open vs laparoscopic. Am J Surg. 2015;209:385-390. http://doi.org/10.1016/j.amjsurg.2014.07.012
Vettoretto N, Carrara A, Corradi A, et al. Laparoscopic adhesiolysis: consensus conference guidelines. Colorectal Dis. 2012;14:208-215. http://doi.org/10.1111/j.1463-1318.2012.02968.x
Byrne J, Saleh F, Ambrosini L, et al. Laparoscopic versus open surgical management of adhesive small bowel obstruction: a comparison of outcomes. Surg Endosc. 2015;29:2525-2532. http://doi.org/10.1007/s00464-014-4015-7
Alemayehu H, David B, Desai AA, et al. Laparoscopy for small bowel obstruction in children – an update. J Laparoendosc Adv Surg Tech A. 2015;25:73-76. http://doi.org/10.1089/lap.2014.0228 PMid:25423020
Kelly KN, Iannuzzi JC, Rickles AS, et al. Laparotomy for small-bowel obstruction: First choice or last resort for adhesiolysis? A laparoscopic approach for small-bowel obstruction reduces 30-day complications. Surg Endosc. 2014;28:65-73. http://doi.org/10.1007/s00464-013-3162-6
Lee J, Tashjian DB, Moriarty KP. Surgical management of pediatric adhesive bowel obstruction. J Laparoendosc Adv Surg Tech. A. 2012;22:917-920. http://doi.org/10.1089/lap.2012.0069
O’Connor DB, Winter DC. The role of laparoscopy in the management of acute small-bowel obstruction: a review of over 2,000 cases. Surg Endosc. 2012;26:12-17. http://doi.org/10.1007/s00464-011-1885-9
Robb WB, Mariette C. Strategies in the prevention of the formation of postoperative adhesions in digestive surgery: a systematic review of the literature. Dis Colon Rectum. 2014;57:1228-1240. http://doi.org/10.1097/DCR.0000000000000191
Scott FI, Osterman MT, Mahmoud NN, Lewis JD. Secular trends in small-bowel obstruction and adhesiolysis in the United States: 1988–2007. Am J Surg. 2012;204:315-320. http://doi.org/10.1016/j.amjsurg.2011.10.023
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.