Page 3 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Laparoscopic vs Open Surgical Management of Adhesive

Bowel Obstruction in Children: A Retrospective Study

Comparing the Outcomes at a Tertiary Care Center for

Pediatric Surgery

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Sunil Kumar , Amar AA Alnaqi , Yousuf A Khan , Aisha Khan , Vipul Gupta , Suad Abul , Abdulla Ali , Esmaeel Taqi ,
Ashraf Alkholy 9
AbstrAct
Background: Laparoscopic approach for management of adhesive bowel obstruction has become an established technique both in adults and
children. There is an increased need of reporting of the outcome using this method of treatment in pediatric practice.
Aim: To compare the outcome of laparoscopic vs open surgery in children with adhesive bowel obstruction.
Materials and methods: Data were collected on children with adhesive bowel obstruction who were managed at a tertiary care level center
for pediatric surgery from January 2007 to September 2017. Patients who were successfully managed by conservative management were
excluded. Also the cases in which laparoscopic procedure was converted into an open surgery were excluded. Factors such as operative time,
need for total parenteral nutrition, time to resume oral feeds, postoperative length of hospital stay, and complications during or after surgery
were studied in laparoscopic and open group.
Results: Eighty children with adhesive intestinal obstruction were admitted. Eight were managed conservatively hence excluded. Forty-two
were managed by open surgery and laparoscopic management was performed for 30. Four (10.3%) out of these were converted into open
laparotomy. These were also excluded. Operative time was not significantly different between open (122 minutes) vs laparoscopic group (138
minutes). During dissection, complications like serosal tear were higher (20 vs 0) in the open group. Resection anastomosis (15 cases) and
wound infections (6 cases) rate was also higher with open laparotomy. Mean time in days to start oral feeds (2.5 vs 5.9) and length of hospital
stay (5.5 vs 11.3) was significantly shorter in laparoscopic group.
Conclusion: Laparoscopic management of adhesive bowel obstruction in children is safe and is associated with early postoperative recovery,
shorter hospital stay and lower complication rate in comparison with open surgical management of these cases.
Keywords: Adhesive bowel obstruction, Laparoscopic management, Open laparotomy.
World Journal of Laparoscopic Surgery (2019): 10.5005/jp-journals-10033-1382

IntroductIon 1–9 Department of Pediatric Surgery, Ibn Sina Hospital, Kuwait

Postoperative adhesions are an inevitable outcome of abdominal Corresponding Author: Sunil Kumar, Department of Pediatric
surgery in both adult and pediatric populations. Up to 90–95% Surgery, Ibn Sina Hospital, Kuwait, Phone: +965 66018599, e-mail:
of adult patients develop intra-abdominal adhesions following sunilyadav90@hotmail.com
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a laparotomy. Incidence of postoperative adhesive bowel How to cite this article: Kumar S, Alnaqi AAA, Khan YA, et al. Laparoscopic
obstruction in children has been reported in the range of 1–5% vs Open Surgical Management of Adhesive Bowel Obstruction in
although it varies according to primary pathology and type of Children: A Retrospective Study Comparing the Outcomes at a Tertiary
operation performed. 3–6 Adhesive bowel obstruction can occur Care Center for Pediatric Surgery. World J Lap Surg 2019;12(3):89–92.

anytime from the early postoperative period after the index Source of support: Nil
operation to many decades later. The management of adhesive Conflict of interest: None
bowel obstruction continues to evolve in both adult and pediatric
patients. Open laparotomy is widely accepted as the standard
approach for patients with adhesive bowel obstruction in whom of both urgent and elective cases still data on the laparoscopic
conservative treatment fails. In recent times, laparoscopic approach treatment of bowel obstruction due to adhesions are scarce. The
has become a widely accepted treatment modality for adhesive purpose of this study was to report our institutional experience
small bowel obstruction in adults because of its advantages like less comparing outcomes in patients with adhesive bowel obstruction
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pain, fast recovery and reduced morbidity. Following its successful treated by laparoscopic adhesiolysis and open laparotomy.
use in adult population, laparoscopic surgery has been increasingly
used for the treatment of adhesive small bowel obstruction in MAterIAls And Methods

children with good outcome. 8–10
Although advanced laparoscopic surgery is now commonly This retrospective study was conducted in the Department of
available in the majority of tertiary pediatric centers for the treatment Pediatric Surgery at Ibn Sina Hospital of Kuwait. This is a Tertiary Care

© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
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