• Brooks V Udelsman, David C Chang, Ralitza Parina, Mark A Talamini, Keith D Lillemoe, and Elan R Witkowski.
• Department of Surgery, Massachusetts General Hospital, Boston, MA.
• Ann. Surg. 2020 May 1; 271 (5): 898-905.

ObjectiveThe objective of this study was to determine the effects of open versus laparoscopic surgery on the development of adhesive small bowel obstruction (aSBO).Summary Background DataaSBO is a significant contributor to short and long-term postoperative morbidity. Laparoscopy has demonstrated a protective effect in colorectal surgery, but these effects have not been generalized to other abdominal procedures.MethodsPopulation level California state data (1995-2010) was analyzed. We identified patients who underwent Roux-en-Y gastric bypass (RYGB), cholecystectomy, partial colectomy, appendectomy, and hysterectomy. The primary outcome was aSBO. Clinical, patient, and hospital characteristics were assessed using Kaplan-Meir methodology and Cox regression analysis adjusting for demographics, comorbidities, and operative approach.ResultsWe included 1,612,629 patients with a median follow-up of 6.3 years. The 5-year incidence rate of aSBO was higher after open surgery compared with laparoscopic surgery for each procedure (RYGB 2.1% vs. 1.5%, P < 0.001; cholecystectomy 2.2% vs. 0.65%, P < 0.001; partial colectomy 5.5% vs. 2.8%, P < 0.001; appendectomy 0.58% vs. 0.35%, P < 0.001; and hysterectomy 0.89% vs. 0.54%, P < 0.001). The period of greatest risk for aSBO formation was within the first 2-years. In multivariate analysis, an open approach was associated with an increased risk of aSBO for each procedure [RYGB hazard ratio (HR) 1.24, P < 0.001; cholecystectomy HR 1.89, P < 0.001; partial colectomy HR 1.49, P < 0.001; appendectomy HR 1.45, P < 0.001; and hysterectomy HR 1.16, P < 0.001).ConclusionsLaparoscopy is associated with a significant and sustained reduction in the rate of aSBO. The period of greatest risk for aSBO is within the first 2 years after surgery.

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