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 Purpose: Laparoscopy is being used increasingly for the management of small bowel obstructions (SBOs), but only a few studies have examined the indications and utility of laparoscopic surgery in SBO. This study investigated the feasibility, effectiveness and safety of laparoscopic surgery in SBO, as well as the predictors of the success or failure of laparoscopic surgery.

Methods: From June 2006 to March 2010, 73 patients underwent surgery for SBO at the Department of Surgery, Kyung Hee University Medical Center. The patients treated by laparoscopy were compared with those treated by laparotomy in terms of the differences in operative time, postoperative hospital stay and return of bowel function, as evidenced by the toleration of a liquid diet, surgical site infection and recurrence rate. A Chi-square test, student's t-test and ANOVA test were performed to identify the predictors of success or failure of laparoscopic surgery, particularly the preoperative laboratory findings, vital signs, previous abdominal surgery, duration of illness, bowel diameter on abdomen plain film and location of the transition zone on computerized tomography.

Results: Of the 73 cases, 30 cases were in the laparoscopic group (41.1%) and 43 cases were in the laparotomy group (58.9%). The postoperative hospital stay was significantly shorter in the laparoscopic group than in the laparotomy group (8.1±5.8 vs. 15.2±14.9 days, p=0.04), and the period until the return of bowel function was significantly shorter in the laparoscopic group than laparotomy group (4.3±3.1 vs. 6.6±3.6 days, p=0.02). The surgical site infection rate tended to be lower in the laparoscopic group than in the laparotomy group (4.5% vs. 23.3%, p=0.07) and the mean surgery time tended to be shorter in the laparoscopic group than in the laparotomy group (76.3±28.1 vs. 96.3±55.9 minutes, p=0.06). There were no differences in the incidence of intraoperative bowel injury between the two groups (0/22 (0%) in the laparoscopic group vs. 2/43 (4.7%) in the laparotomy group, p=0.30), recurrence rate (0/22 (0%) vs. 3/43 (7.1%), p=0.34) and mortality rate (1/22 (4.5%) vs 0/43 (0%), p=0.30 respectively). The rate of conversion to open surgery was 26.7% (8/30). The causes of conversion to open surgery were severe bowel distension (2 cases), severe adhesion (2 cases), no visible cause of obstruction (1 case), iatrogenic bowel injury (1 case), bowel ischemia and perforation (1 case) and hemodynamic instability (1 case). There were no significant differences in the preoperative WBC count, CRP, pulse rate, number of past abdominal surgeries, duration of illness, bowel diameter on plain abdominal film and obstruction site between the successful group and conversion group, except for the significant differences in body temperature and marginal differences in the type of previous surgery.

Conclusion: The laparoscopic approach has been shown to be safe and feasible in the management of SBO for selected patients. There were no pre-operative predictive factors for successful laparoscopy, except for factors such as afebrility and previous gynecological surgery. Nevertheless, larger, randomized prospective trials will be needed to determine the predictors of success or failure of laparoscopic surgery.

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원위부 췌장 절제에 있어서 복강경 수술과 개복 수술의 비교 : 수술 후 췌장루 발생을 중심으로 박호종, 나양원, 남창우, 방성조 pp.42-50

단일 지렛대 원리를 이용한 단일통로 복강경 담낭절제술 : 변형된 단일절개, 다투관침 방법 장지영, 최성훈, 황호경, 강창무, 이우정 pp.51-55

Early experience of single-port laparoscopic anterior resection for colon cancer Woo-Yeon Kim, Byung-Jo Choi, Kwan-Ju Lee, Say-June Kim, Jeong-Goo Kim, Dong-Ho Lee, Sang-Chul Lee pp.56-60

직장암에서 da Vinci 로봇수술시스템을 이용한 직장절제술 : 185예의 단기 성적 분석 이동원, 백세진, 신재원, 조재승, 김진, 김선한 pp.61-67

Laparoscopic colorectal surgery is safe for elderly patients over the age of 70 Soo Hyun Lee, Byung Mo Kang, Kil Yeon Lee, Sun Jin Park, Suk-Hwan Lee pp.68-73

무기복 복강경 보조 경제대 충수절제술 정성우, 문현종, 이종인, 이종훈 pp.74-79

천공성 충수염에서 복강경 충수 절제술의 유용성 김태구, 정기훈, 정호근 pp.80-83

(The)feasibility of laparoscopic surgery in the management of small bowel obstruction Sang Hyun Kim, Bum Soo Kim, Yong Ho Kim, Sung Il Choi pp.84-90

하복부 수술의 과거력이 있는 환자들에게 시행한 복강경 전복막외접근 탈장교정술의 초기 경험 조대현, 김범수, 최성일, 주선형, 이상목 pp.91-95

서혜부 탈장 환자에 대한 전복막외접근 복강경 탈장교정술 : 92예의 경험 김선국, 박신희, 최상용, 김행수, 김택현 pp.96-100

소아의 단순 및 천공성 충수염에서 개복 및 복강경 충수절제술의 비교 이동운, 김수홍, 정성은, 박귀원, 조아해, 김현영 pp.101-105

시행한 복강경 복막 투석 도관 삽입술과 개복 삽입술의 비교 연구 홍석균, 김수홍, 하일수, 정성은, 박귀원, 김현영 pp.106-110

Laparoscopic resection of an asymptomatic intra-abdominal lymphangioma Kee Hoon Hyun, Jun Ho Park, Su Yun Choi, Won Hyuk Choi, Jin Cheol Jeong, Doo Jin Kim, Joo Seop Kim, Samuel Lee pp.111-113

고도비만환자에게 시행한 로봇 루와이 위우회술 1예 및 로봇 위소매절제술 1예 보고 박도중, 안상훈, 이주희, 김형호 pp.114-117

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