Background
Small bowel obstruction (SBO) is a common surgical emergency most frequently caused by adhesions. A large portion of adhesive SBO resolve by nonoperative methods such as fasting and ingestion of an oral contrast-media, while a significant number of patients will need emergency surgery. For decades open surgery has been the gold standard in treating adhesive SBO. Now that laparoscopic surgery has been established as a first line option in many elective indications such as colorectal surgery, fundoplication, and cholecystectomy for example, laparoscopy is emerging also as a viable alternative in emergency surgery.
If SBO is caused by one adhesive band, the surgical treatment is straightforward - cutting the band causing obstruction. Laparoscopic approach seems ideal for such a procedure, preventing the morbidity of a laparotomy incision. First publications describing laparoscopic adhesiolysis in SBO are from the 1990's. Since then several retrospective series have been published, and a recent meta-analysis pooled patients from four studies, including a total of 334 patients. Meta-analysis showed that patients treated by the laparoscopic approach had less complications, and faster return of bowel function. However, there are no prospective randomized trials comparing open approach to laparoscopy. Furthermore, previous retrospective studies have a selection bias because the easiest cases are selected for laparoscopic approach. One of the drawbacks of laparoscopic approach is a concern for iatrogenic bowel perforation. In one report, the rate of bowel lesion in laparoscopic adhesiolysis was 6.6%, and only 84% were detected during the operation.