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Causes for Conversion in Laparoscopic Treatment of Mechanical Ileus

D. Andonov, I. Ivanov, A. Filipov, M. Tabakov

Abstract


Small bowel obstruction is a major cause of emergency hospitalization in surgical wards. Most patients respond to conservative therapy, but 30% require surgery. Conventional surgical treatment is performed by laparotomy. The laparoscopic access is not widespread because of the supposed high risk of visceral damage, difficult access and limited workspace. We present our experience in the use of laparoscopy in the diagnosis and treatment of small bowel ileus, and the most common causes for conversion.Materials and Methods: From 2009 to 2016, in the clinic, laparoscopy for diagnostic and therapeutic purposes has been performed in 82 patients with clinical and paraclinical data for intestinal obstruction. All surgical procedures were performed by surgeons experienced in laparoscopic surgery. The average age of the operated was 53.5 years (21-86 years) and 70.7% (58/82) were female. The average BMI of the patients was 28kg/m2 (22-34). 30.4% (25) had a prior episode of intestinal obstruction. Among this group, there were no patients with peritonitis.Results: Conversion was necessary in 28 (34.1%) patients. We accept as conversion every time when a laparotomy was made, regardless of the occasion. The reasons for the conversions were: ischemic necrosis requiring resection in 4 cases, 1 patient with mesenteric thrombosis, 1 iatrogenic perforation, 18 difficult explorations, where a diagnosis was impossible to make, and 4 due to inability to perform adhesiolysis.Intraoperative complications were observed in two patients in the early phase of the study - iatrogenic small bowel perforations.The reason for this was using the wrong instrument for manipulating the bowel - dissector. For the first patient, conversion and suture were performed, for the second - laparoscopic suture.Conclusion: Laparotomy is still the gold standard for treatment of intestinal obstruction, but laparoscopy is an appropriate diagnostic tool of identifying the causes of intestinal obstruction with high therapeutic efficiency. Still, a very large number of patients required conversion to open surgery. The long learning curve and the improper selection of patients could be considered as the main reasons for this.

Keywords

Keywords: Laparoscopic surgery, ileus, mechanical ileus




DOI: http://dx.doi.org/10.14748/ssm.v48i0.2303

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About The Authors

D. Andonov

I. Ivanov

A. Filipov

M. Tabakov

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