open access

https://hdl.handle.net/2115/97590

Is Exploratory Laparoscopy the Optimal Surgical Strategy for Small Bowel Obstruction? A Single-Center Retrospective Cohort Study With Propensity Score-Matched Analysis

英語

Small bowel obstruction

2025-04-06

John Wiley & Sons

Asian journal of endoscopic surgery

18(1)

e70056

Introduction No consensus exists on the optimal surgical strategy for small bowel obstruction (SBO). Therefore, we assessed the feasibility of laparoscopic surgery (LS) for SBO by comparing LS and open surgery (OS) outcomes.Methods We retrospectively analyzed 303 patients who underwent surgery for SBO. The characteristics of 233 patients who underwent exploratory LS, including 43 who underwent open conversion surgery (OCS) and 70 who underwent OS, were propensity score-matched to compare surgical outcomes. Risk factors and a predictive model for OCS were also investigated.Results After matching, patients who underwent LS had smaller hemorrhage volumes, fewer severe postoperative complications, and shorter postoperative hospital stays than those who underwent OS. Furthermore, the recurrence rates were comparable. The surgical outcomes of patients who underwent OCS were generally inferior to those of patients who completed LS and were almost equivalent to those of patients who underwent OS. A history of abdominal surgery, serum albumin level <= 3.8 g/dL, platelet count <= 15 x 104/mu L, and neutrophil-to-lymphocyte ratio >= 6.7 were identified as independent risk factors for OCS. The OCS risk was significantly higher when the predictive model for conversion to OS was derived from risk factors scoring >= 10.Conclusion Overall, LS for SBO yields better outcomes than OS. Even in patients with a high predicted risk of conversion to OS, exploratory laparoscopy should be the primary surgical procedure for treating SBO.

学術雑誌論文

Accepted Manuscript

This is the peer reviewed version of the following article: Furukawa, S., Kato, K., Susa, Y., Yamabuki, T., Takada, M., Kinoshita, Y., Anbo, Y., Nakamura, F. and Hirano, S. (2025), Is Exploratory Laparoscopy the Optimal Surgical Strategy for Small Bowel Obstruction? A Single-Center Retrospective Cohort Study With Propensity Score-Matched Analysis. Asian J Endosc Surg, 18: e70056. https://doi.org/10.1111/ases.70056, which has been published in final form at https://doi.org/10.1111/ases.70056. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.

1758-5902

1758-5910