JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Volume 25, Number 8, 2015 ª Mary Ann Liebert, Inc. DOI: 10.1089/lap.2014.0446
Full Report
Laparoscopic Versus Open Bowel Resection in Emergency Small Bowel Obstruction: Analysis of the National Surgical Quality Improvement Program Database Rohit Sharma, MD,1 Subhash Reddy, MBBS,2 David Thoman, MD,1 Jonathan Grotts, MA,1 and Lisa Ferrigno, MD, MPH1
Abstract
Background: Small bowel obstruction (SBO) is commonly encountered by surgeons and has traditionally been handled via an open approach, especially when small bowel resection (SBR) is indicated, although recent series have shown improved outcomes with a laparoscopic approach. In this retrospective study, we sought to evaluate outcomes and identify risk factors for adverse events after emergency SBR for SBO with an emphasis on surgical approach. Materials and Methods: In this retrospective review using American College of Surgeons National Surgical Quality Improvement Program data, 1750 patients were identified who had emergency SBR with the principal diagnosis of SBO from 2006 to 2011. Mortality and postoperative adverse events were evaluated. Results: Of 1750 patients who had emergency SBR, 51 (2.9%) had laparoscopic bowel resection (LBR). There was no difference in surgery duration (open bowel resection [OBR] versus LBR, 100 minutes versus 92 minutes; P = .38). Compared with the LBR group, the OBR group had a higher rate of baseline cardiac comorbidities and postoperative complications, and their length of stay was longer (10 versus 8 days; P < .001). Using multivariate analysis, perioperative variables of age >70 years, pulmonary, renal, neurological, and cardiac comorbidities, preoperative sepsis, steroid use, and body mass index of 30 kg/m2 Age >70 years Sepsis PVD Renal Diabetes Open repair
Respiratory complication
Overall morbidity
Mortality
OR
P value
OR
P value
OR
P value
OR
P value
— — — — — — 0.8 — — — — 2.9
— — — — — — .025 — — — — .018
1.7 1.4 1.5 1.0 1.5 — 1.6 1.6 2.2 1.7 1.3 6.5
.002 .058 .043 .898 .16 — .001 .001 .02 .101 .224 .011
1.5 1.2 1.8 1.5 — — 1.1 1.2 1.8 1.6 — 2.8
.007 .074 .001 < .001 — — .202 .056 .062 .076 — .003
2.6 1.9 2.1 1.6 2.1 0.6 3.3 1.9 1.6 3.8 — —
< .001 .002 < .001 .01 .013 .035 < .001 < .001 .241 < .001 — —
Those covariates found to be significant in the univariate analyses were included in the multivariate models. BMI, body mass index; CNS, central nervous system; OR, odds ratio; PVD, peripheral vascular disease.
of 25%–35% for the management of SBO from adhesions.4,10–12 With intestinal strangulation being the feared complication of SBO, these higher SBR rates possibly lend support to the old adage to never let the sun rise or set on a bowel obstruction. Despite the obvious advantages, however, current data suggest that laparoscopic resection in this setting is rarely used. Our study shows that a laparoscopic approach to bowel resection can be performed with shorter postoperative recovery time. Risk of wound infection or hernia is minimized with this approach. Our experience with LBR, compared with OBR, leads us to believe that with the former approach, nasogastric tubes can be removed immediately and the patient typically can be discharged the following day with minimal discomfort. We found a significantly shorter length of stay in those who had a laparoscopic approach to SBO compared with the open approach. Although there was significant variability in both the open and laparoscopic groups, our analysis indicates that hospitalization was shortened by a full 2 days in the LBR group. Other studies have shown the laparoscopic approach to confer an even greater reduction in length of stay, with Johnson et al.4 showing a decrease in length of stay from 11 days to 7.7 days when the laparoscopic approach was used. In addition, we found that the overall complication rate was more than halved in the LBR group (OBR versus LBR, 15% for versus 5.9%; P = .041), as was overall morbidity (42% versus 18%, respectively; P < .001), a finding that remained significant after controlling for other factors. This reduction in overall complication rate has been reported in other studies as well. One study examining laparoscopy for lysis of adhesions found a reduction in overall complication rate from 40% to 19% when a laparoscopic approach was used.13 Wound complications have typically been shown to be higher with an open approach to SBO,9,14,15 and this finding is supported in our current analysis (OBR versus LBR, 19.8% versus 7.8%; P = .019). Rates of intraoperative complications with a laparoscopic approach vary in the literature from 3% to 29%6,13,16–18 and were most commonly enterotomies that were identified intraoperatively. However, direct comparison with an open approach has been seldom performed;
Wullstein and Gross13 found the intraoperative complication rate for a laparoscopic approach (19%), conversion to open (19%), and open (15.4%) to be statistically similar. A common misconception of the laparoscopic approach is that it takes more time than an open approach. We have had the opposite experience in a large minimally invasive practice, and there is growing support in the literature. In our analysis, surgical time was equivalent (median, 100 [77.5] versus 92 [60] minutes, respectively; P = .380). Johnson et al.4 found that laparoscopic time was significantly faster, and this included those requiring bowel resection. Several series, not surprisingly, show a significantly increased time in patients converted from laparoscopic to open, perhaps contributing to a reluctance to initiate a laparoscopic approach.6,13 There have been several series evaluating the use of laparoscopy in adhesiolysis in SBO but much fewer focusing specifically on laparoscopic SBR. Indeed, studies evaluating the use of laparoscopy for SBO have either excluded those who needed resection19 or perceived the need for resection as an absolute indication for an open approach.11 Johnson et al.4 found that 53% of those needing surgery for SBO were initially approached laparoscopically, with a subsequent conversion rate of 40%. Of those completed laparoscopically, only 3 patients (8%) received a bowel resection, whereas 64% of those who were converted and 41% of those receiving an open procedure at the onset had a resection, implying that conversions may have been done after recognition that resection was indicated. In our analysis of over 4000 patients undergoing SBR associated with obstruction from adhesive disease, only 2.9% were approached laparoscopically despite a growing body of data to support its safety, decreased morbidity, and lack of added time. As a consequence of the limitations of the NSQIP database, we were not able to identify operative conversions from laparoscopic to open, nor can this information be obtained from databases using billing information. Indeed, there is a lack of consensus in the literature as to what actually constitutes a ‘‘laparoscopic approach.’’ Does the addition of a ‘‘mini-laparotomy’’ incision for externalization of affected bowel for resection and anastomoses constitute conversion,
LAPAROSCOPIC VERSUS OPEN BOWEL RESECTION
despite the fact that it likely confers similar benefits?20 Most reports consider the addition of this incision a conversion to the open procedure,11,21 whereas some consider this technique a variant of a successful laparoscopic approach.22 For example, Johnson et al.4 used an incision size of 3 cm as a cutoff to be considered open versus laparoscopic. The impact such variations in technique have is unknown and further supports the need for a randomized trial. One such prospective trial by Sallinen et al.23 is currently underway and should provide more insight into the use of laparoscopy in the treatment of adhesive SBOs. Lastly, we were unable to evaluate other potential benefits that others have found with the laparoscopic approach. Some such benefits that are proving to be consistent in the literature are quicker return of bowel function and decreased postoperative pain.5,6,8 As noted in the Eastern Association for the Surgery of Trauma guidelines for SBO,24 the choice for the laparoscopic approach may be in part dependent on the surgeon’s experience and comfort with the approach for SBO. Undoubtedly, this would also play a role in the comfort level and ability to perform a bowel resection and anastomosis without laparotomy. The increased experience of today’s trainees in advanced laparoscopy compared with 10–20 years ago should be taken into consideration in future recommendations and assessments of laparoscopic SBR. Given the potential advantages to patients, LBR with anastomosis should undergo consideration as a core competency in training. Furthermore, consensus statements condemning a laparoscopic approach to a strangulated bowel need to be reconsidered. Although many reports in the realm of surgical education have focused on the decreased number of open cases that residents perform,25 this would be a way to capitalize on today’s evolving skillsets. Disclosure Statement
No competing financial interests exist. S.R. and D.T. are responsible for the study idea. D.T. and L.F. are responsible for study supervision. J.G. is responsible for data assimilation and analysis. All authors are responsible for manuscript preparation. L.F. and D.T. had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. References
1. Hayanga AJ, Bass-Wilkins K, Bulkley GB. Current management of small-bowel obstruction. Adv Surg 2005;39:1–33. 2. Miller G, Boman J, Shrier I, Gordon PH. Natural history of patients with adhesive small bowel obstruction. Br J Surg 2000;87:1240–1247. 3. Welch J. General consideration and mortality in bowel obstruction. In: Welch JP (ed). Bowel Obstruction: Differential Diagnosis and Clinical Management. Philadelphia: Saunders, 1990, pp. 59–95. 4. Johnson KN, Chapital AB, Harold KL, Merritt MV, Johnson DJ. Laparoscopic management of acute small bowel obstruction: Evaluating the need for resection. J Trauma Acute Care Surg 2012;72:25–30; discussion 30–31; quiz 317. 5. Strickland P, Lourie DJ, Suddleson EA, Blitz JB, Stain SC. Is laparoscopy safe and effective for treatment of acute small-bowel obstruction? Surg Endosc 1999;13: 695–698.
5
6. Zerey M, Sechrist CW, Kercher KW, Sing RF, Matthews BD, Heniford BT. Laparoscopic management of adhesive small bowel obstruction. Am Surg 2007;73:773–778; discussion 778–779. 7. Zerey M, Sechrist CW, Kercher KW, Sing RF, Matthews BD, Heniford BT. The laparoscopic management of smallbowel obstruction. Am J Surg 2007;194:882–887; discussion 887–888. 8. Nagle A, Ujiki M, Denham W, Murayama K. Laparoscopic adhesiolysis for small bowel obstruction. Am J Surg 2004; 187:464–470. 9. Szomstein S, Lo Menzo E, Simpfendorfer C, Zundel N, Rosenthal RJ. Laparoscopic lysis of adhesions. World J Surg 2006;30:535–540. 10. Schraufnagel D, Rajaee S, Millham FH. How many sunsets? Timing of surgery in adhesive small bowel obstruction: A study of the Nationwide Inpatient Sample. J Trauma Acute Care Surg 2013;74:181–187; discussion 187–189. 11. Ghosheh B, Salameh JR. Laparoscopic approach to acute small bowel obstruction: review of 1061 cases. Surg Endosc 2007;21:1945–1949. 12. Margenthaler JA, Longo WE, Virgo KS, Johnson FE, Grossmann EM, Schifftner TL, Henderson WG, Khuri SF. Risk factors for adverse outcomes following surgery for small bowel obstruction. Ann Surg 2006;243:456–464. 13. Wullstein C, Gross E. Laparoscopic compared with conventional treatment of acute adhesive small bowel obstruction. Br J Surg 2003;90:1147–1151. 14. Chopra R, McVay C, Phillips E, Khalili TM. Laparoscopic lysis of adhesions. Am Surg 2003;69:966–968. 15. Duepree H-J, Senagore AJ, Delaney CP, Fazio VW. Does means of access affect the incidence of small bowel obstruction and ventral hernia after bowel resection? J Am Coll Surg 2003;197:177–181. 16. Diaz JJ, Bokhari F, Mowery N, Acosta, JA, Block EF, Bromberg WJ, Collier BR, Cullinane DC, Dwyer KM, Griffen Margaret M, Mayberry JC, and Jerome R. Guidelines for management of small bowel obstruction. J Trauma 2008; 64(6):1651–1664. 17. 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. 18. Suter M, Zermatten P, Halkic N, Martinet O, Bettschart V. Laparoscopic management of mechanical small bowel obstruction: Are there predictors of success or failure? Surg Endosc 2000;14:478–483. 19. Mancini GJ, Petroski GF, Lin WC, Sporn E, Miedema BW, Thaler K. Nationwide impact of laparoscopic lysis of adhesions in the management of intestinal obstruction in the US. J Am Coll Surg 2008;207:520–526. 20. Vettoretto N, Carrara A, Corradi A, De Vivo G, Lazzaro L, Ricciardelli L, Agresta F, Amodio C, Bergamini C, Borzellino G, Catani M, Cavaliere D, Cirocchi R, Gemini S, Mirabella A, Palasciano N, Piazza D, Piccoli M, Rigamonti M, Scatizzi M, Tamborrino E, Zago M; Italian Association of Hospital Surgeons. Laparoscopic adhesiolysis: Consensus conference guidelines. Colorectal Dis 2012;14:e208–e215. 21. Pearl JP, Marks JM, Hardacre JM, Ponsky JL, Delaney CP, Rosen MJ. Laparoscopic treatment of complex small bowel obstruction: Is it safe? Surg Innov 2008;15:110–113. 22. Kirshtein B, Roy-Shapira A, Lantsberg L, Avinoach E, Mizrahi S. Laparoscopic management of acute small bowel obstruction. Surg Endosc 2005;19:464–467.
6
23. Sallinen V, Wikstrom H, Victorzon M, Salminen P, Koivukangas V, Haukija¨rvi E, Enholm B, Leppa¨niemi A, Mentula P. Laparoscopic versus open adhesiolysis for small bowel obstruction—A multicenter, prospective, randomized, controlled trial. BMC Surg 2014;11:14:77. 24. Maung AA, Johnson DC, Piper GL, Barbosa RR, Rowell SE, Bokhari F, Collins JN, Gordon JR, Ra JH, Kerwin AJ; Eastern Association for the Surgery of Trauma. Evaluation and management of small-bowel obstruction: An Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surgery 2012;73(5 Suppl 4):S362–S369.
SHARMA ET AL.
25. McCoy AC, Gasevic E, Szlabick RE, Sahmoun AE, Sticca RP. Are open abdominal procedures a thing of the past? An analysis of graduating general surgery residents’ case logs from 2000 to 2011. J Surg Educ 2013;70:683–689.
Address correspondence to: David Thoman, MD Santa Barbara Cottage Hospital 400 West Pueblo Street Santa Barbara, CA 93102 E-mail: [email protected]
Full Report
Laparoscopic Versus Open Bowel Resection in Emergency Small Bowel Obstruction: Analysis of the National Surgical Quality Improvement Program Database Rohit Sharma, MD,1 Subhash Reddy, MBBS,2 David Thoman, MD,1 Jonathan Grotts, MA,1 and Lisa Ferrigno, MD, MPH1
Abstract
Background: Small bowel obstruction (SBO) is commonly encountered by surgeons and has traditionally been handled via an open approach, especially when small bowel resection (SBR) is indicated, although recent series have shown improved outcomes with a laparoscopic approach. In this retrospective study, we sought to evaluate outcomes and identify risk factors for adverse events after emergency SBR for SBO with an emphasis on surgical approach. Materials and Methods: In this retrospective review using American College of Surgeons National Surgical Quality Improvement Program data, 1750 patients were identified who had emergency SBR with the principal diagnosis of SBO from 2006 to 2011. Mortality and postoperative adverse events were evaluated. Results: Of 1750 patients who had emergency SBR, 51 (2.9%) had laparoscopic bowel resection (LBR). There was no difference in surgery duration (open bowel resection [OBR] versus LBR, 100 minutes versus 92 minutes; P = .38). Compared with the LBR group, the OBR group had a higher rate of baseline cardiac comorbidities and postoperative complications, and their length of stay was longer (10 versus 8 days; P < .001). Using multivariate analysis, perioperative variables of age >70 years, pulmonary, renal, neurological, and cardiac comorbidities, preoperative sepsis, steroid use, and body mass index of 30 kg/m2 Age >70 years Sepsis PVD Renal Diabetes Open repair
Respiratory complication
Overall morbidity
Mortality
OR
P value
OR
P value
OR
P value
OR
P value
— — — — — — 0.8 — — — — 2.9
— — — — — — .025 — — — — .018
1.7 1.4 1.5 1.0 1.5 — 1.6 1.6 2.2 1.7 1.3 6.5
.002 .058 .043 .898 .16 — .001 .001 .02 .101 .224 .011
1.5 1.2 1.8 1.5 — — 1.1 1.2 1.8 1.6 — 2.8
.007 .074 .001 < .001 — — .202 .056 .062 .076 — .003
2.6 1.9 2.1 1.6 2.1 0.6 3.3 1.9 1.6 3.8 — —
< .001 .002 < .001 .01 .013 .035 < .001 < .001 .241 < .001 — —
Those covariates found to be significant in the univariate analyses were included in the multivariate models. BMI, body mass index; CNS, central nervous system; OR, odds ratio; PVD, peripheral vascular disease.
of 25%–35% for the management of SBO from adhesions.4,10–12 With intestinal strangulation being the feared complication of SBO, these higher SBR rates possibly lend support to the old adage to never let the sun rise or set on a bowel obstruction. Despite the obvious advantages, however, current data suggest that laparoscopic resection in this setting is rarely used. Our study shows that a laparoscopic approach to bowel resection can be performed with shorter postoperative recovery time. Risk of wound infection or hernia is minimized with this approach. Our experience with LBR, compared with OBR, leads us to believe that with the former approach, nasogastric tubes can be removed immediately and the patient typically can be discharged the following day with minimal discomfort. We found a significantly shorter length of stay in those who had a laparoscopic approach to SBO compared with the open approach. Although there was significant variability in both the open and laparoscopic groups, our analysis indicates that hospitalization was shortened by a full 2 days in the LBR group. Other studies have shown the laparoscopic approach to confer an even greater reduction in length of stay, with Johnson et al.4 showing a decrease in length of stay from 11 days to 7.7 days when the laparoscopic approach was used. In addition, we found that the overall complication rate was more than halved in the LBR group (OBR versus LBR, 15% for versus 5.9%; P = .041), as was overall morbidity (42% versus 18%, respectively; P < .001), a finding that remained significant after controlling for other factors. This reduction in overall complication rate has been reported in other studies as well. One study examining laparoscopy for lysis of adhesions found a reduction in overall complication rate from 40% to 19% when a laparoscopic approach was used.13 Wound complications have typically been shown to be higher with an open approach to SBO,9,14,15 and this finding is supported in our current analysis (OBR versus LBR, 19.8% versus 7.8%; P = .019). Rates of intraoperative complications with a laparoscopic approach vary in the literature from 3% to 29%6,13,16–18 and were most commonly enterotomies that were identified intraoperatively. However, direct comparison with an open approach has been seldom performed;
Wullstein and Gross13 found the intraoperative complication rate for a laparoscopic approach (19%), conversion to open (19%), and open (15.4%) to be statistically similar. A common misconception of the laparoscopic approach is that it takes more time than an open approach. We have had the opposite experience in a large minimally invasive practice, and there is growing support in the literature. In our analysis, surgical time was equivalent (median, 100 [77.5] versus 92 [60] minutes, respectively; P = .380). Johnson et al.4 found that laparoscopic time was significantly faster, and this included those requiring bowel resection. Several series, not surprisingly, show a significantly increased time in patients converted from laparoscopic to open, perhaps contributing to a reluctance to initiate a laparoscopic approach.6,13 There have been several series evaluating the use of laparoscopy in adhesiolysis in SBO but much fewer focusing specifically on laparoscopic SBR. Indeed, studies evaluating the use of laparoscopy for SBO have either excluded those who needed resection19 or perceived the need for resection as an absolute indication for an open approach.11 Johnson et al.4 found that 53% of those needing surgery for SBO were initially approached laparoscopically, with a subsequent conversion rate of 40%. Of those completed laparoscopically, only 3 patients (8%) received a bowel resection, whereas 64% of those who were converted and 41% of those receiving an open procedure at the onset had a resection, implying that conversions may have been done after recognition that resection was indicated. In our analysis of over 4000 patients undergoing SBR associated with obstruction from adhesive disease, only 2.9% were approached laparoscopically despite a growing body of data to support its safety, decreased morbidity, and lack of added time. As a consequence of the limitations of the NSQIP database, we were not able to identify operative conversions from laparoscopic to open, nor can this information be obtained from databases using billing information. Indeed, there is a lack of consensus in the literature as to what actually constitutes a ‘‘laparoscopic approach.’’ Does the addition of a ‘‘mini-laparotomy’’ incision for externalization of affected bowel for resection and anastomoses constitute conversion,
LAPAROSCOPIC VERSUS OPEN BOWEL RESECTION
despite the fact that it likely confers similar benefits?20 Most reports consider the addition of this incision a conversion to the open procedure,11,21 whereas some consider this technique a variant of a successful laparoscopic approach.22 For example, Johnson et al.4 used an incision size of 3 cm as a cutoff to be considered open versus laparoscopic. The impact such variations in technique have is unknown and further supports the need for a randomized trial. One such prospective trial by Sallinen et al.23 is currently underway and should provide more insight into the use of laparoscopy in the treatment of adhesive SBOs. Lastly, we were unable to evaluate other potential benefits that others have found with the laparoscopic approach. Some such benefits that are proving to be consistent in the literature are quicker return of bowel function and decreased postoperative pain.5,6,8 As noted in the Eastern Association for the Surgery of Trauma guidelines for SBO,24 the choice for the laparoscopic approach may be in part dependent on the surgeon’s experience and comfort with the approach for SBO. Undoubtedly, this would also play a role in the comfort level and ability to perform a bowel resection and anastomosis without laparotomy. The increased experience of today’s trainees in advanced laparoscopy compared with 10–20 years ago should be taken into consideration in future recommendations and assessments of laparoscopic SBR. Given the potential advantages to patients, LBR with anastomosis should undergo consideration as a core competency in training. Furthermore, consensus statements condemning a laparoscopic approach to a strangulated bowel need to be reconsidered. Although many reports in the realm of surgical education have focused on the decreased number of open cases that residents perform,25 this would be a way to capitalize on today’s evolving skillsets. Disclosure Statement
No competing financial interests exist. S.R. and D.T. are responsible for the study idea. D.T. and L.F. are responsible for study supervision. J.G. is responsible for data assimilation and analysis. All authors are responsible for manuscript preparation. L.F. and D.T. had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. References
1. Hayanga AJ, Bass-Wilkins K, Bulkley GB. Current management of small-bowel obstruction. Adv Surg 2005;39:1–33. 2. Miller G, Boman J, Shrier I, Gordon PH. Natural history of patients with adhesive small bowel obstruction. Br J Surg 2000;87:1240–1247. 3. Welch J. General consideration and mortality in bowel obstruction. In: Welch JP (ed). Bowel Obstruction: Differential Diagnosis and Clinical Management. Philadelphia: Saunders, 1990, pp. 59–95. 4. Johnson KN, Chapital AB, Harold KL, Merritt MV, Johnson DJ. Laparoscopic management of acute small bowel obstruction: Evaluating the need for resection. J Trauma Acute Care Surg 2012;72:25–30; discussion 30–31; quiz 317. 5. Strickland P, Lourie DJ, Suddleson EA, Blitz JB, Stain SC. Is laparoscopy safe and effective for treatment of acute small-bowel obstruction? Surg Endosc 1999;13: 695–698.
5
6. Zerey M, Sechrist CW, Kercher KW, Sing RF, Matthews BD, Heniford BT. Laparoscopic management of adhesive small bowel obstruction. Am Surg 2007;73:773–778; discussion 778–779. 7. Zerey M, Sechrist CW, Kercher KW, Sing RF, Matthews BD, Heniford BT. The laparoscopic management of smallbowel obstruction. Am J Surg 2007;194:882–887; discussion 887–888. 8. Nagle A, Ujiki M, Denham W, Murayama K. Laparoscopic adhesiolysis for small bowel obstruction. Am J Surg 2004; 187:464–470. 9. Szomstein S, Lo Menzo E, Simpfendorfer C, Zundel N, Rosenthal RJ. Laparoscopic lysis of adhesions. World J Surg 2006;30:535–540. 10. Schraufnagel D, Rajaee S, Millham FH. How many sunsets? Timing of surgery in adhesive small bowel obstruction: A study of the Nationwide Inpatient Sample. J Trauma Acute Care Surg 2013;74:181–187; discussion 187–189. 11. Ghosheh B, Salameh JR. Laparoscopic approach to acute small bowel obstruction: review of 1061 cases. Surg Endosc 2007;21:1945–1949. 12. Margenthaler JA, Longo WE, Virgo KS, Johnson FE, Grossmann EM, Schifftner TL, Henderson WG, Khuri SF. Risk factors for adverse outcomes following surgery for small bowel obstruction. Ann Surg 2006;243:456–464. 13. Wullstein C, Gross E. Laparoscopic compared with conventional treatment of acute adhesive small bowel obstruction. Br J Surg 2003;90:1147–1151. 14. Chopra R, McVay C, Phillips E, Khalili TM. Laparoscopic lysis of adhesions. Am Surg 2003;69:966–968. 15. Duepree H-J, Senagore AJ, Delaney CP, Fazio VW. Does means of access affect the incidence of small bowel obstruction and ventral hernia after bowel resection? J Am Coll Surg 2003;197:177–181. 16. Diaz JJ, Bokhari F, Mowery N, Acosta, JA, Block EF, Bromberg WJ, Collier BR, Cullinane DC, Dwyer KM, Griffen Margaret M, Mayberry JC, and Jerome R. Guidelines for management of small bowel obstruction. J Trauma 2008; 64(6):1651–1664. 17. 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. 18. Suter M, Zermatten P, Halkic N, Martinet O, Bettschart V. Laparoscopic management of mechanical small bowel obstruction: Are there predictors of success or failure? Surg Endosc 2000;14:478–483. 19. Mancini GJ, Petroski GF, Lin WC, Sporn E, Miedema BW, Thaler K. Nationwide impact of laparoscopic lysis of adhesions in the management of intestinal obstruction in the US. J Am Coll Surg 2008;207:520–526. 20. Vettoretto N, Carrara A, Corradi A, De Vivo G, Lazzaro L, Ricciardelli L, Agresta F, Amodio C, Bergamini C, Borzellino G, Catani M, Cavaliere D, Cirocchi R, Gemini S, Mirabella A, Palasciano N, Piazza D, Piccoli M, Rigamonti M, Scatizzi M, Tamborrino E, Zago M; Italian Association of Hospital Surgeons. Laparoscopic adhesiolysis: Consensus conference guidelines. Colorectal Dis 2012;14:e208–e215. 21. Pearl JP, Marks JM, Hardacre JM, Ponsky JL, Delaney CP, Rosen MJ. Laparoscopic treatment of complex small bowel obstruction: Is it safe? Surg Innov 2008;15:110–113. 22. Kirshtein B, Roy-Shapira A, Lantsberg L, Avinoach E, Mizrahi S. Laparoscopic management of acute small bowel obstruction. Surg Endosc 2005;19:464–467.
6
23. Sallinen V, Wikstrom H, Victorzon M, Salminen P, Koivukangas V, Haukija¨rvi E, Enholm B, Leppa¨niemi A, Mentula P. Laparoscopic versus open adhesiolysis for small bowel obstruction—A multicenter, prospective, randomized, controlled trial. BMC Surg 2014;11:14:77. 24. Maung AA, Johnson DC, Piper GL, Barbosa RR, Rowell SE, Bokhari F, Collins JN, Gordon JR, Ra JH, Kerwin AJ; Eastern Association for the Surgery of Trauma. Evaluation and management of small-bowel obstruction: An Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surgery 2012;73(5 Suppl 4):S362–S369.
SHARMA ET AL.
25. McCoy AC, Gasevic E, Szlabick RE, Sahmoun AE, Sticca RP. Are open abdominal procedures a thing of the past? An analysis of graduating general surgery residents’ case logs from 2000 to 2011. J Surg Educ 2013;70:683–689.
Address correspondence to: David Thoman, MD Santa Barbara Cottage Hospital 400 West Pueblo Street Santa Barbara, CA 93102 E-mail: [email protected]
