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Background <p>Adhesive etiologies accounts for 60–70% of all small bowel obstructions (SBO), resulting in over 300,000 annual US hospitalizations. While the majority resolve non-operatively, 25–40% will require surgery. With advancements in minimally invasive surgical (MIS) techniques and increasing laparoscopic proficiency, there has been a shift from traditional exploratory laparotomy towards MIS approaches. This study evaluated national trends and compare outcomes between open and MIS approaches for SBO. </p> Methods <p>Using the American College of Surgeons National Surgical Quality Improvement Project (NSQIP) patient registry, we identified patients with SBO from 2011 to 2021 and classified their surgical management (open vs MIS) based on CPT codes. We analyzed trends, demographics, complications, mortality, and length of stay (LOS) using Chi-square and Mann–Whitney U tests. A binary logistic regression model was used to assess risk factors for complications.</p> Results <p>Of 25,533 cases of SBO identified, 35% were treated via MIS approaches, which increased from 27 to 45% between 2011–2021 (p &lt; 0.001). Open approaches were more common in males (66.9% vs 63.1%, p &lt; 0.001), older patients (65 vs 63&#xa0;years, p &lt; 0.001), and those with higher ASA scores (ASA 3–4: 71% vs ASA 1–2: 58%, p &lt; 0.001). MIS had lower rates of complications (15.2% vs 27.7%, p &lt; 0.001), mortality (1.3% vs 3.9%, p &lt; 0.001), and LOS (4 vs 8&#xa0;days, p &lt; 0.001). Multivariable analysis demonstrated MIS as a protective factor for any complication (OR 0.53, 95% CI 0.49–0.57, p &lt; 0.001).</p> Conclusions <p>MIS utilization for SBO has significantly increased over the past decade, demonstrating lower complication rates, mortality, and shorter LOS compared to open surgery. While these results support MIS adoption, patient selection remains crucial, considering factors like age, comorbidities, and surgical complexity including previous surgery.</p>

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A decade-long nationwide analysis of surgical management of adhesive small bowel obstruction: Open vs. laparoscopic approach

  • 期刊论文

  • 发表日期：

    2025年12月11日

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  • Anibal La Riva,
  • Rafael H. Perez-Soto,
  • Justin Bauzon,
  • Juan S. Barajas-Gamboa,
  • Sol Lee,
  • Salvador Navarrete,
  • Ricard Corcelles,
  • Andrew Strong,
  • Jerry Dang,
  • Matthew Kroh,
  • Gustavo Romero-Velez

摘要

Background

Adhesive etiologies accounts for 60–70% of all small bowel obstructions (SBO), resulting in over 300,000 annual US hospitalizations. While the majority resolve non-operatively, 25–40% will require surgery. With advancements in minimally invasive surgical (MIS) techniques and increasing laparoscopic proficiency, there has been a shift from traditional exploratory laparotomy towards MIS approaches. This study evaluated national trends and compare outcomes between open and MIS approaches for SBO.

Methods

Using the American College of Surgeons National Surgical Quality Improvement Project (NSQIP) patient registry, we identified patients with SBO from 2011 to 2021 and classified their surgical management (open vs MIS) based on CPT codes. We analyzed trends, demographics, complications, mortality, and length of stay (LOS) using Chi-square and Mann–Whitney U tests. A binary logistic regression model was used to assess risk factors for complications.

Results

Of 25,533 cases of SBO identified, 35% were treated via MIS approaches, which increased from 27 to 45% between 2011–2021 (p < 0.001). Open approaches were more common in males (66.9% vs 63.1%, p < 0.001), older patients (65 vs 63 years, p < 0.001), and those with higher ASA scores (ASA 3–4: 71% vs ASA 1–2: 58%, p < 0.001). MIS had lower rates of complications (15.2% vs 27.7%, p < 0.001), mortality (1.3% vs 3.9%, p < 0.001), and LOS (4 vs 8 days, p < 0.001). Multivariable analysis demonstrated MIS as a protective factor for any complication (OR 0.53, 95% CI 0.49–0.57, p < 0.001).

Conclusions

MIS utilization for SBO has significantly increased over the past decade, demonstrating lower complication rates, mortality, and shorter LOS compared to open surgery. While these results support MIS adoption, patient selection remains crucial, considering factors like age, comorbidities, and surgical complexity including previous surgery.