The risk of developing a small-bowel obstruction after open surgery is about fourfold higher when compared with laparoscopic surgery in nine commonly performed abdominal and pelvic procedures, including cholecystectomy, hysterectomy, and appendectomy, investigators reported.
Other factors such as patient age, , prior abdominal surgery, and comorbidities also contributed to the risk of SBO, the study showed. However, laparoscopy "exceeded other risk factors in reduction of the risk of SBO for most of the surgical procedures," wrote Dr. Eva Angenete and her colleagues (Arch. Surg. 2012;147:359-65).
"This study shows that, beyond important factors such as age, previous abdominal surgery, and comorbidity, the surgical technique is the most important factor related to SBO," the authors wrote. "Compared with laparoscopic surgery, open surgery seems to increase the risk of SBO at least four times."
It’s likely that the study results will hold up to further scrutiny because the study was population based and the sample size – 108,141 patients – is large, the authors said.
Still, laparoscopic surgery did not seem to reduce the incidence of SBO in some groups, including hysterectomy patients. "One hypothesis is that this result may be related to a limited dissection in the pelvis," but the small number of laparoscopic hysterectomy patients included in the study could have affected the study’s results, the authors wrote. In addition, there were no clear risk factors for SBO in patients undergoing bariatric surgery, they wrote.
The investigators used the Inpatient Register of the Swedish National Board of Health and Welfare to analyze the risk of SBO in nine procedures, including cholecystectomy, hysterectomy, salpingo-oophorectomy, bowel resection, anterior resection, abdominoperineal resection, rectopexy, appendectomy, and bariatric surgery performed from 2002 to 2004. The database included information on demographic characteristics, comorbidities, previous abdominal surgery, and deaths.
The rate of SBO was lowest after cholecystectomy, occurring in just 0.4% of all cases, and was highest, at 13.9%, in abdominoperineal resection patients. For most surgical procedures, patients who had SBO were older on average. SBO was also more common in patients with previous abdominal surgery.
In those who underwent cholecystectomy, bowel resection, or appendectomy, a higher level of comorbidity was associated with a greater incidence of SBO, the authors said. In the group of complicated cholecystectomy patients as well as the group of anterior resection patients, SBO was more common among men.
SBO was linked with an increased risk of death within 5 years, the study found.
"The aim of this study was to identify the incidence and risk factors for mechanical SBO after a number of common abdominal and pelvic procedures," the authors wrote. "Small-bowel obstruction is a substantial health care challenge, and correctly identified risk factors can provide improved tools to reduce the risk of SBO after an abdominal surgical procedure."
"The safety and the short-term benefits of laparoscopy are already known, and it is possible that laparoscopy should be regarded as the preferred technique in an attempt to further reduce the complications of surgery," the authors concluded.
The project was supported by grants from the Swedish Cancer Foundation, the Swedish Medical Association, the Gothenburg Medical Association, the Assar Gabrielsson Foundation, the Magn Berwall’s Foundation, and the Swedish Research Council. None of the funding sources had any role in the study or the preparation of the manuscript. The authors reported no financial conflicts of interest.
