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

Ab s t r Ac t 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.