Laparoscopic versus open adhesiolysis in patients with adhesive small bowel obstruction: a systematic review and meta-analysis

BACKGROUND: The objective of this study was to evaluate whether surgical outcomes differ between laparoscopy versus the open approach for adhesive small bowel obstruction. METHODS: PubMed, MEDLINE, Embase, and the Cochrane Library databases were electronically searched from 1985 to 2010. The study pooled the effects of outcomes of a total of 334 patients enrolled into 4 retrospective comparative studies using meta-analytic methods. RESULTS: Laparoscopic adhesiolysis was associated with a reduced overall complication rate (odds ratio = .42, .25-.70, P < .01), prolonged ileus rate (odds ratio = .28, .10-.73, P = .01) and pulmonary complication rate (odds ratio = .20, .04-.94, P = .04) compared with the open approach. No significant differences were noted for intraoperative injury to bowel rates (odds ratio = 1.93,.76-4.89, P = .17), wound infection rates (odds ratio = .44, .17-1.12, P = .08), and mortality (odds ratio = .81, .12-5.49, P = .83). CONCLUSIONS: Laparoscopic adhesiolysis is advantageous in most of the analyzed outcomes. Laparoscopic treatment of small bowel obstruction is recommended by experienced laparoscopic surgeons in selected patients. (C) 2012 Elsevier Inc. All rights reserved.