外科杂志

Minimally Invasive Surgery for Small Bowel Obstruction: The Experience of a Tertiary Hospital in the Anglo-Caribbean

Abstract

Nigel Bascombe, Kelly-Ann Bobb and Dilip Dan

Objectives: The aim of this study was to access the feasibility and benefit of minimally invasive surgery for Small Bowel Obstruction in a tertiary hospital in Trinidad and Tobago.

Design and Methods: All patients with clinical and radiologically diagnosed small bowel obstruction, who had nil resolution with conservative management at 48 hours, or who had nil passage of oral contrast into the colon at 12 hours, were included in this case series. Exclusion criteria included: anesthesiological contraindication for laparoscopy. The primary endpoints were resolution of obstruction (time to first bowel movement, time to commencement of oral feeds) and length of hospital stay. Secondary endpoints included overall morbidity and operative complications (bleeding, subphrenic or pelvic intraabdominal abscesses, wound infections, respiratory complications), during and after hospitalisation.

Results: There were five (5) patients who meet the inclusion criteria for this case series from January 2014 to March 2015. 40% (2/5) of the patients were female. The mean age was 38.4 yrs. Conversion rate was 0%. The enterotomy rate was 20% (1/5). The median duration of postoperative ileus was 5 days. . The median duration of postoperative hospital stay was 5.6 days, mean time to enteral feeds was 1.8 days. Rate of post-operative complications was 20% (1/5).

Conclusion: With appropriate patient selection, minimally invasive surgery is a safe alternative to open surgery for SBO, with acceptable morbidity and mortality.