Early laparoscopic adhesiolysis versus conservative treatment of recurrent adhesive small intestinal obstruction: a prospective randomized controlled trial

Background
Adhesive small bowel obstruction (ASBO) represents a common clinical problem following previous abdominal surgery. The recurrence rate after an ASBO admission is high, especially after conservative treatment. Retrospective studies suggest that laparoscopic approach shortens hospital stays and reduces complications in these patients. However, there are no prospective randomized, controlled trials comparing early laparoscopic adhesiolysis with conservative treatment of recurrent ASBO.
Patients and methods
A prospective, randomized, controlled study was conducted on 51 patients admitted with the diagnosis of recurrent postoperative ASBO to compare early laparoscopic adhesiolysis with conservative treatment in patients with computed tomography-diagnosed ASBO. The outcome of the study was evaluated depending on the length of postoperative hospital stay, passage of stool, commencement of enteral nutrition, 30-day mortality, complications, the length of sick leave, and recurrence of small bowel obstruction during follow-up for 2 years.
Results
A total of 51 patients with a diagnosis of recurrent small bowel obstruction were identified and divided into two groups. A total of 26 patients were treated with laparoscopic adhesiolysis (23 patients were successfully treated and three patients needed open surgery) and showed significantly low recurrence, short hospital stay, and early regain of bowel movement. A total of 25 patients underwent conservative treatment, which was filed in three cases that needed surgical interference. There was no significant difference between the two groups as regards morbidity and mortality.
Conclusion
Laparoscopically treated patients with recurrent ASBO had a lower frequency of recurrence and a longer time interval to recurrence. They also had a shorter hospital stay and early start of oral feeding compared with patients treated nonoperatively. Laparoscopy in well-trained hand may help in the treatment of recurrent ASBO with fewer complications.