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. 2023 Aug 25:14:100213.
doi: 10.1016/j.sipas.2023.100213. eCollection 2023 Sep.

"Choice of surgical approach for the treatment of acute small bowel obstruction: A retrospective analysis from a high-volume single center in Milan, Northern Italy"

E Ortolano  1 , C Maina  1 , A D'Addiego  1 , C Ciuffa  2 , S I Rocchetti  1 , A A Beneduce  1 , M Carlucci  1
Affiliations

"Choice of surgical approach for the treatment of acute small bowel obstruction: A retrospective analysis from a high-volume single center in Milan, Northern Italy"

E Ortolano et al. Surg Pract Sci. .

Abstract

Background: Acute small bowel obstruction (aSBO) is the most common cause (76%) of acute intestinal obstruction. Laparoscopy use is still controversial in aSBO and indications not yet clearly defined. The aim of this study was to demonstrate the effectiveness and safety of a laparoscopic approach in aSBO by using specific pre-operative criteria for appropriate patient selection.

Methods: We retrospectively analyzed medical records of patients accepted at the Emergency Department for aSBO between January 2016 and March 2021 and performed a comparative analysis between types of treatment, considering demographics, clinical and radiological presentation, non-operative vs. operative management, intraoperative outcome, and postoperative course. We used a logistic regression to identify the variables related to surgical approach and built a predictive score upon the multivariable predictive model: the "SABO score".

Results: 198 patients were included in the study, of which 145 underwent surgery and 43 were successfully treated laparoscopically. Age and comorbidities were associated with open surgery (OR 3.2, 95% CI: 1.4-7.2, p = 0.006 and OR 2.7, 95% CI: 1.1-6.5, p = 0.023). A SABO score ≥ 0 identified an open approach with a sensitivity of 75.4% and a specificity of 69.8%.

Conclusions: Laparoscopy is growing in importance even in emergency settings. Our analysis suggests that a laparoscopic approach can be safe and feasible in aSBO management. Correct patient selection appears to be the key for a successful minimally invasive approach. SABO score therefore could be helpful in choosing the correct surgical strategy for patients with aSBO.

Keywords: Emergency surgery; Laparoscopy; Small bowel obstruction.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Image, graphical abstract
Graphical abstract
Fig. 1
Fig. 1
Cases flowchart according to exclusion criteria.
Fig. 2
Fig. 2
Receiver Operating Characteristic (ROC) curve analysis to assess the discriminative ability of the SABO score Caption: AUC: 0.752, p < 0.001.
Fig. 3
Fig. 3
SABO score distribution among laparotomic vs. minimally invasive subgroups. Caption: The graphic on the left (red) shows SABO score distribution in laparotomic subgroup, the graphic on the right (black) shows SABO score distribution in laparoscopic subgroup.
See this image and copyright information in PMC

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