In these cases, it is important to consider the bowel diameter, degree of abdominal distention, and location of the obstruction (ie, proximal or distal). Suter et al.  found that a bowel diameter exceeding 4 cm was associated with an increased rate of conversion: 55% versus 32%. Patients with a distal and complete small bowel obstruction have an increased incidence of intraoperative complications and increased risk of conversion. Patients with persistent abdominal distention after nasogastric intubation are also unlikely to be
treated successfully with laparoscopy. The influence of dense adhesions and the number of previous operations on the success of laparoscopic adhesiolysis is controversial. León et al. state that a documented history of severe or extensive dense adhesions is a contraindication
BI 10773 supplier to laparoscopy . In contrast, Suter et al. selleck compound found no correlation between the number and or type of previous surgeries and the chance of a successful laparoscopic surgery . Other factors such as an elevated white blood cell count or a fever have not been demonstrated to correlate with an increased conversion rate. One group of patients who are good candidates for laparoscopic adhesiolysis are those with a nonresolving, partial small bowel obstruction or a recurrent, chronic small bowel obstruction demonstrated on contrast study [61, 62]. In an Irish systematic review of over 2000 cases of ASBO, 1284 (64%) were successfully treated with a laparoscopic approach, 6.7% were lap-assisted, and 0.3% were converted to hernia repair; the overall conversion rate to midline laparotomy was 29%. Dense adhesions, bowel resection, unidentified pathology and iatrogenic injury accounted for the majority of conversions. When the etiology was attributed to a single-band adhesion, the success rate was 73.4%. Morbidity and mortality were respectively 14.8% and 1.5%. The
inadvertent enterotomy rate was 6.6%. In this perspective laparoscopy seems to be feasible and effective treatment for ASBO with acceptable morbidity . Navez et al. reported that when the cause of obstruction was a single band, laparoscopic adhesiolysis was successful 100% of the time . When other etiologies are found, such as LY3039478 manufacturer internal hernia, inguinal hernia, neoplasm, inflammatory bowel disease, intussusception, and gallstone Carnitine palmitoyltransferase II ileus, conversion to a minilaparotomy or a formal laparotomy is often required. Inadvertent enterotomy during reopening of the abdomen or subsequent adhesion dissection is a feared complication of surgery after previous laparotomy. The incidence can be as high as 20% in open surgery and between 1% and 100% in laparoscopy . The incidence of intraoperative enterotomies during laparoscopic adhesiolysis ranges from 3% to 17.6%, with most authors reporting an incidence of about 10% [66, 67]. One of the most dreaded complications of surgery is a missed enterotomy.