• Pepijn Krielen, Salomone Di Saverio, Richard Ten Broek, Claudio Renzi, Mauro Zago, Georgi Popivanov, Paolo Ruscelli, Rinaldo Marzaioli, Massimo Chiarugi, and Roberto Cirocchi.
• From the Department of Surgery (P.K., R.t.B.), Radboud university medical center, Nijmegen, The Netherlands; Cambridge Colorectal Unit (S.D.S.), Addenbrooke's Hospital, Cambridge, United Kingdom; Department of Surgical Sciences (C.R., R.C.), University of Perugia, Perugia; Minimally Invasive Surgery Unit (M.Z.), Policlinico San Pietro, Ponte San Pietro, Italy; Department of Surgery (G.P.), Military Medical Academy, Sofia, Bulgaria; Emergency Surgery Unit (P.R.), Torrette Hospital, Ancona; Department of Emergency and Organ Transplantation (R.M.), AUOP Giovanni XXIII, Bari; and Emergency Surgery Unit (M.C.), Azienda Ospedaliero Universitaria Pisana Cisanello Hospital, Pisa, Italy.
• J Trauma Acute Care Surg. 2020 Jun 1; 88 (6): 866-874.

BackgroundAdhesive small bowel obstruction (ASBO) is one of the most frequent causes of emergency hospital admissions and surgical treatment. Current surgical treatment of ASBO consists of open adhesiolysis. With laparoscopic procedures rising, the question arises if laparoscopy for ASBO is safe and results in better patient outcomes. Although adhesiolysis was among the first surgical procedures to be approached laparoscopically, uncertainty remains about its potential advantages over open surgery. Therefore, we performed a systematic review and meta-analysis on the benefits and harms of laparoscopic surgery for ASBO.MethodsA systematic literature review was conducted for articles published up to May 2019. Two reviewers screened all articles and did the quality assessment. Consecutively a meta-analysis was performed. To reduce selection bias, only matched studies were used in our primary analyses. All other studies were used in a sensitivity analyses. All the outcomes were measured within the 30th postoperative day. Core outcome parameters were postoperative mortality, iatrogenic bowel perforations, length of postoperative stay [days], severe postoperative complications, and early readmissions. Secondary outcomes were operative time [min], missed iatrogenic bowel perforations, time to flatus [days], and early unplanned reoperations.ResultsIn our meta-analysis, 14 studies (participants = 37.007) were included: 1 randomized controlled trial, 2 matched studies, and 11 unmatched studies. Results of our primary analyses show no significant differences in core outcome parameters (postoperative mortality, iatrogenic bowel perforations, length of postoperative stay, severe postoperative complications, early readmissions). In sensitivity analyses, laparoscopic surgery favored open adhesiolysis in postoperative mortality (relative risk [RR], 0.36; 95% CI, 0.29-0.45), length of postoperative hospital stay (mean difference [MD], -4.19; 95% CI, -4.43 to -3.95), operative time (MD, -18.19; 95% CI, -20.98 to -15.40), time to flatus (MD, -0.98; 95% CI, -1.28 to -0.68), severe postoperative complications (RR, 0.51; 95% CI, 0.46-0.56) and early unplanned reoperations (RR, 0.82; 95% CI, 0.70-0.96).ConclusionResults of this systematic review indicate that laparoscopic surgery for ASBO is safe and feasible. Laparoscopic surgery is not associated with better or worse postoperative outcomes compared with open adhesiolysis. Future research should focus on the correct selection of those patients who are suitable for laparoscopic approach and may benefit from this approach.Level Of EvidenceSystematic Review/Meta-analysis, Level III.

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