Intraabdominal adhesions are the inevitable result of abdominal operations.1 Postoperative adhesions are not always symptomatic, but a small percentage do become symptomatic as an acute or chronic small bowel obstruction. An adhesive small bowel obstruction is estimated to develop in 3% of all patients who have undergone laparotomy.2 Beck et al.3 reviewed 18,912 patients with open abdominal surgery and found 14.3% had obstruction within 2 years, with 2.6% requiring adhesiolysis. Moreover, the incidence increases significantly after major abdominal operations and reoperation causes more adhesions.4
The goal of surgical treatment of acute small bowel obstruction should focus on avoiding operative delay and reducing the morbidity associated with bowel strangulation.5 In the early era of laparoscopy, prior abdominal surgery was a relative contraindication to treat acute small bowel obstruction. According to this concept, laparotomy has been used in the treatment of small bowel obstruction caused by postoperative adhesions. But today, with the development of improved laparoscopic operative techniques and devices, laparoscopic lysis of adhesions for acute and chronic small bowel obstruction does have a role in some instances.6,7
Because laparoscopic approaches have some advantages with less pain, early recovery of bowel movement, less problems about abdominal wall cicatrization, a shorter hospital stay and incapacitation of patient activity, and an improved aesthetic effect,8 there remains some hope that some of these benefits would be realized in laparoscopic adhesiolysis. Especially important is the theoretical advantage that the development of fewer postoperative adhesions compared with open laparotomy and fewer wound complications would result in a lower risk of subsequent obstructions.9
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