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Minimally invasive surgical approach to small bowel obstruction
Due to the lack of laparoscopic experience to work in a small space (small bowel distension), small bowel obstruction seems to be a relative contraindication for a minimally invasive approach. In other hands, many patients have co-morbidities, and consequently it is key to work with a low intra-abdominal pressure to prevent any conversion for pneumoperitoneum intolerance. Small bowel obstruction must be resolved by experts in order to prevent any excessive mobilization and iatrogenic perforation.

Critical comments:
This video presents the laparoscopic management of bowel obstruction. It demonstrates the feasibility of the identification and management of mechanical bowel obstruction. Several parts of the video can be discussed:
1. In their comments, the authors report that the whole bowel has to be explored in order to prevent the presence of a secondary band at the origin of the obstruction. This is absolutely mandatory. Usually, the recommendation is to start the exploration at the level of the caecum and to mobilize the whole non-dilated bowel in order to prevent a risk of bowel injury during this manipulation. Exploration of the dilated bowel is much more risky. The authors did not show this extensive and systematic exploration.
2. The authors reported that they used 5 to 10 liters of warm saline for abdominal lavage. Today, there is no evidence of the benefit of this major abdominal lavage including 5 to 10 liters. Selective lavage can be recommended in case of significant bacterial contamination.
3. The authors consider the potential benefit of irrigation of the ischemic bowel with hot water after band division. This indication can be considered as potentially efficient regarding the recommendations in open surgery. However, laparoscopy has a significant advantage to keep the internal temperature of 37°C at a minimum, and certainly hot lavage, which cannot be over 39°C to 40°C, will probably also have limited impact.
Despite these minor remarks, this video has a scientific value in demonstrating a safe approach to a small bowel obstruction related to a single band, which is, in this case, very safely resected.
One can also focus on the value of working with a high quality camera, which gives the surgeon the possibility to clearly evaluate the vitality of the small bowel after an ischemic period, which is well demonstrated in this video.
S Rua, F Silveira, P Mira
Surgical intervention
3 years ago
1338 views
61 likes
0 comments
06:59
Minimally invasive surgical approach to small bowel obstruction
Due to the lack of laparoscopic experience to work in a small space (small bowel distension), small bowel obstruction seems to be a relative contraindication for a minimally invasive approach. In other hands, many patients have co-morbidities, and consequently it is key to work with a low intra-abdominal pressure to prevent any conversion for pneumoperitoneum intolerance. Small bowel obstruction must be resolved by experts in order to prevent any excessive mobilization and iatrogenic perforation.

Critical comments:
This video presents the laparoscopic management of bowel obstruction. It demonstrates the feasibility of the identification and management of mechanical bowel obstruction. Several parts of the video can be discussed:
1. In their comments, the authors report that the whole bowel has to be explored in order to prevent the presence of a secondary band at the origin of the obstruction. This is absolutely mandatory. Usually, the recommendation is to start the exploration at the level of the caecum and to mobilize the whole non-dilated bowel in order to prevent a risk of bowel injury during this manipulation. Exploration of the dilated bowel is much more risky. The authors did not show this extensive and systematic exploration.
2. The authors reported that they used 5 to 10 liters of warm saline for abdominal lavage. Today, there is no evidence of the benefit of this major abdominal lavage including 5 to 10 liters. Selective lavage can be recommended in case of significant bacterial contamination.
3. The authors consider the potential benefit of irrigation of the ischemic bowel with hot water after band division. This indication can be considered as potentially efficient regarding the recommendations in open surgery. However, laparoscopy has a significant advantage to keep the internal temperature of 37°C at a minimum, and certainly hot lavage, which cannot be over 39°C to 40°C, will probably also have limited impact.
Despite these minor remarks, this video has a scientific value in demonstrating a safe approach to a small bowel obstruction related to a single band, which is, in this case, very safely resected.
One can also focus on the value of working with a high quality camera, which gives the surgeon the possibility to clearly evaluate the vitality of the small bowel after an ischemic period, which is well demonstrated in this video.
Acute small bowel obstruction two months after laparoscopic rectal prolapse surgery: laparoscopic management
Acute small bowel obstruction (SBO) is an ever-increasing clinical problem. In this video, the authors demonstrate the laparoscopic management of acute small bowel obstruction. Its successful management depends on a comprehensive knowledge of the etiology and pathophysiology of obstruction, familiarity with imaging methods, good clinical judgment, and sound technical skills. The adoption of laparoscopy in the treatment of SBO has been slow because of concerns for iatrogenic bowel injury and working space issues related to bowel distension.
In this film, the authors demonstrate that it is essential to rapidly manage the patient after the first acute attack.
Although there is an inherent appeal for laparoscopy in its potential to minimize short- and long-term wound complications and perioperative laparotomy-related morbidity and to theoretically induce fewer subsequent adhesions than a traditional laparotomy incision would.

Small bowel obstruction is a pathology commonly found in the current practice of surgical emergencies. The main cause stems from surgical history with a variable onset of symptoms. The introduction of laparoscopic surgery helped to slightly reduce the number of patients presenting with occlusive syndromes. The rapid management of occlusive patients is one of the keys to success. Consequently, once diagnosis has been evoked, imaging studies must be performed, and especially CT-scan, in order to determine the type of obstruction, its mechanism and its severity. After work-up, either a conservative medical treatment or surgery will be decided upon.
L Marx, J Leroy, J Marescaux
Surgical intervention
6 years ago
2996 views
20 likes
0 comments
04:19
Acute small bowel obstruction two months after laparoscopic rectal prolapse surgery: laparoscopic management
Acute small bowel obstruction (SBO) is an ever-increasing clinical problem. In this video, the authors demonstrate the laparoscopic management of acute small bowel obstruction. Its successful management depends on a comprehensive knowledge of the etiology and pathophysiology of obstruction, familiarity with imaging methods, good clinical judgment, and sound technical skills. The adoption of laparoscopy in the treatment of SBO has been slow because of concerns for iatrogenic bowel injury and working space issues related to bowel distension.
In this film, the authors demonstrate that it is essential to rapidly manage the patient after the first acute attack.
Although there is an inherent appeal for laparoscopy in its potential to minimize short- and long-term wound complications and perioperative laparotomy-related morbidity and to theoretically induce fewer subsequent adhesions than a traditional laparotomy incision would.

Small bowel obstruction is a pathology commonly found in the current practice of surgical emergencies. The main cause stems from surgical history with a variable onset of symptoms. The introduction of laparoscopic surgery helped to slightly reduce the number of patients presenting with occlusive syndromes. The rapid management of occlusive patients is one of the keys to success. Consequently, once diagnosis has been evoked, imaging studies must be performed, and especially CT-scan, in order to determine the type of obstruction, its mechanism and its severity. After work-up, either a conservative medical treatment or surgery will be decided upon.
Laparoscopic treatment of acute small bowel obstruction: multiple cases of laparoscopic adhesiolysis
The video shows the laparoscopic management of three separate cases of acute small bowel obstruction secondary to adhesions. The difficulties and advantages of such an approach in this emergency scenario are discussed.
The author begins by inserting a trocar in the umbilicus. Upon exploration of the abdominal cavity, intestinal obstruction becomes clearly evident from the presence of dilated loops and flattened, collapsed loops. The author follows the collapsed loops until the transition zone is identified. The adhesions appear between the greater omentum and the mesentery. This band is divided. Further exploration leads to the finding of a second adhesion. This area shows no signs of occlusion. The author divides this adhesion. Exploration of the remainder of the small bowel continues to rule out further adhesions.
F Costantino, J Marescaux
Surgical intervention
11 years ago
3974 views
45 likes
0 comments
09:41
Laparoscopic treatment of acute small bowel obstruction: multiple cases of laparoscopic adhesiolysis
The video shows the laparoscopic management of three separate cases of acute small bowel obstruction secondary to adhesions. The difficulties and advantages of such an approach in this emergency scenario are discussed.
The author begins by inserting a trocar in the umbilicus. Upon exploration of the abdominal cavity, intestinal obstruction becomes clearly evident from the presence of dilated loops and flattened, collapsed loops. The author follows the collapsed loops until the transition zone is identified. The adhesions appear between the greater omentum and the mesentery. This band is divided. Further exploration leads to the finding of a second adhesion. This area shows no signs of occlusion. The author divides this adhesion. Exploration of the remainder of the small bowel continues to rule out further adhesions.