Results of laparoscopic surgery in management of small bowel obstruction for patients previously operated on for intra-abdominal malignancy at K Hospital

Abstract

Abstract Introduction: Laparoscopic surgery of postoperative small bowel obstruction had been put into practice. There were some studies on the results in this issue for post appendectomy and gynecology or post cholecystectomy but the results in surgery post upper and/or lower median incision and post cancer digestive or post malignant intra- abdominal operations have not been much studied. In National Cancer Hospital as known as K hospital, laparoscopic surgery of post operative small bowel obstruction due to strangulation , volvulus or simple adhesion (short adhesion) have not been put into operation up to now. We therefore conducted our retrospective study aimed at evaluating the results of post operative small bowel obstruction surgery in patients previously operated on for intra-abdominal malignancy or gynecology Patient and method: Retrospective study. It was conducted between 2019-2023 Result: There were 22 patients, male 16 patients (72,7%), female 6 patients (27,3 %), mean age 59,2 (range 32-70). All underwent one abdominal surgery (upper and/or lower median incision ). 72,7 % had emergency surgery of post operative small bowel obstruction (POSBO) < 24 h the onset symptoms;27,3 % > 24 h the initial symptoms. 95% of them had fluid air level on plain abdominal X-ray. CT scan revealed 3 transition points. Per-operative lesions: 45,45 % had band adhesive obstruction (strangulation); 22,,27 % had volvulus due to simple and short adhesion, 13,6% (3 patients) had intestinal necrosis due to adhesive volvulus (2 patients), other had internal hernia; 3 remained patients had phytobezoar obstruction post gastrectomy. Laparostomy performed in 86,3 %, laparoscopic surgery in 13,7 %. No death per and after operation was occurred .One had developed the digestive cutaneous fistulas due to bowel resection was resolved by medical treatment. Conclusion: Laparoscopic surgery could be performed for patients undergoing previous surgery for intra-abdominal malignancy or gynecology pathologies. The success rate of laparoscopic or laparoscopic assisted surgery could be obtained for strangulations or volvulus, and simple adhesion (short adhesion) as well as phytobezoar obstructions. Key word: Post operative small bowel obstruction, laparoscopy, adhesiolysis