LAPAROSCOPIC VERSUS OPEN SURGERY FOR ACUTE ADHESIVE SMALL-BOWEL OBSTRUCTION : A PROPENSITY SCORE-MATCHED ANALYSIS

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Hackenberg , T , Mentula , P , Leppaniemi , A & Sallinen , V 2017 , ' LAPAROSCOPIC VERSUS OPEN SURGERY FOR ACUTE ADHESIVE SMALL-BOWEL OBSTRUCTION : A PROPENSITY SCORE-MATCHED ANALYSIS ' , Scandinavian Journal of Surgery , vol. 106 , no. 1 , pp. 28-33 . https://doi.org/10.1177/1457496916641341

Title: LAPAROSCOPIC VERSUS OPEN SURGERY FOR ACUTE ADHESIVE SMALL-BOWEL OBSTRUCTION : A PROPENSITY SCORE-MATCHED ANALYSIS
Author: Hackenberg, T.; Mentula, P.; Leppaniemi, A.; Sallinen, V.
Other contributor: University of Helsinki, Clinicum
University of Helsinki, II kirurgian klinikka
University of Helsinki, Pertti Panula / Principal Investigator






Date: 2017-03
Language: eng
Number of pages: 6
Belongs to series: Scandinavian Journal of Surgery
ISSN: 1457-4969
DOI: https://doi.org/10.1177/1457496916641341
URI: http://hdl.handle.net/10138/236700
Abstract: Background and Aims: The laparoscopic approach has been increasingly used to treat adhesive small-bowel obstruction. The aim of this study was to compare the outcomes of a laparoscopic versus an open approach for adhesive small-bowel obstruction. Material and Methods: Data were retrospectively collected on patients who had surgery for adhesive small-bowel obstruction at a single academic center between January 2010 and December 2012. Patients with a contraindication for the laparoscopic approach were excluded. A propensity score was used to match patients in the laparoscopic and open surgery groups based on their preoperative parameters. Results: A total of 25 patients underwent laparoscopic adhesiolysis and 67 patients open adhesiolysis. The open adhesiolysis group had more suspected bowel strangulations and more previous abdominal surgeries than the laparoscopic adhesiolysis group. Severe complication rate (Clavien-Dindo 3 or higher) was 0% in the laparoscopic adhesiolysis group versus 14% in the open adhesiolysis group (p = 0.052). Twenty-five propensity score-matched patients from the open adhesiolysis group were similar to laparoscopic adhesiolysis group patients with regard to their preoperative parameters. Length of hospital stay was shorter in the laparoscopic adhesiolysis group compared to the propensity score-matched open adhesiolysis group (6.0 vs 10.0 days, p = 0.037), but no differences were found in severe complications between the laparoscopic adhesiolysis and propensity score-matched open adhesiolysis groups (0% vs 4%, p = 0.31). Conclusion: Patients selected to be operated by the open approach had higher preoperative morbidity than the ones selected for the laparoscopic approach. After matching for this disparity, the laparoscopic approach was associated with a shorter length of hospital stay without differences in complications. The laparoscopic approach may be a preferable approach in selected patients.
Subject: Laparoscopy
small-bowel obstruction
randomized controlled trial
adhesiolysis
complication
retrospective
emergency
acute abdomen
OPEN SURGICAL-MANAGEMENT
OPEN ADHESIOLYSIS
LAPAROTOMY
OUTCOMES
TRIAL
3126 Surgery, anesthesiology, intensive care, radiology
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