Tasa de conversi?3n y morbilidad en el abordaje laparosc?3pico en pacientes seleccionados con obstrucci?3n intestinal adherencial

摘要

Introduction: Adherence syndrome is the most frequent cause of small bowel obstruction. Laparotomy is the standard approach. The progress of minimally invasive surgery makes it possible to resolve obstructive frames by laparoscopy. Objective: To analyze the laparoscopic approach for intestinal obstruction and compare it with the open pathway. Method: Retrospective analysis of patients treated for acute intestinal obstruction by laparoscopy in our hospital, from 2012 to 2016. A group of patients treated from 2002 to 2005 were used as reference, when only the open approach was used. We analyzed demographic data, surgical risk, comorbidities, diagnostic methods and complications (Clavien). Results: Within the 134 patients operated for acute intestinal obstruction, a laparoscopic approach was started in 47 (35%). Only 32 patients (68%) were completed in this way. The conversion rate was 32%, these patients were eliminated from the study. In the reference group, 32 patients were randomly analyzed. Both groups are comparable. The group treated with laparoscopic approach had 9% complications and 3% reoperations, with a single unexpected lesion. The laparoscopic group had 12.5% of ​​reintervention, all due to evisceration, but had a higher rate of intestinal resections. There was no hospital mortality. Conclusion: In patients who have completed laparoscopic surgery, the results are compared favorably with those of the open approach in a homogeneous historical reference group, and without the added risk of evisceration.