Abstract
There are many problems in the laparoscopic approach to small bowel obstruction, associated with preoperative diagnosis, surgical technique, confirmation at the end of surgery, and conversion to laparotomy. Hence, this procedure appears justified only in a subset of patients. In this manuscript, first, we review and analyze the previous literature for a thorough understanding of the problems underlying laparoscopic surgery. Second, we present our concept for the laparoscopic surgery of small bowel obstruction without limitation for the indication, in which the laparoscopic management is always backed up by a subsequent small laparotomy. Twenty-one patients underwent surgery based on this concept. In no patient was a large laparotomy required, with no reoperation or recurrence of bowel obstruction during a short followup period. A retrospective assessment showed that laparoscopic surgery without laparotomy could have been accomplished in only 5 cases (24%).
