Laparoscopy in Management of Children with Small Bowel Obstruction

Small bowel obstruction caused by adhesions is one of the most common causes of hospital admission among children. Until recently, the presence of symptoms of small bowel obstruction was the contraindication for laparoscopy; however, rapid development of minimally-invasive surgery determined the implementation of these methods in the management of patients with small bowel obstruction. The objective of the research was to summarize our own experience of laparoscopic treatment of children with small bowel obstruction. Materials and methods. The study is based on the results of laparoscopic management of 86 children being operated on during 2007-2015. Laparoscopy was used in 90.7% of patients and laparoscopically assisted procedures were performed in 9.3% of cases. Results. Adhesive small bowel obstruction occurred more often after laparotomy (70.9%), while after laparoscopy it was detected in 16.3% of patients only. During surgical revision of the abdominal cavity, single obstructive bands often in the area of the ileocecal valve were found in 55.8% patients; diffuse dense bands were observed in 31.4% of children; in 12.8% of children twisting of a loop of small bowel around the Meckel’s diverticulum was noted. Laparoscopically assisted procedures were applied in cases that required bowel resection. The postoperative complication rate was 9.3%. Conclusions. In the presence of appropriate skills, laparoscopic adhesiolysis can be a real alternative to conventional laparotomy in treating children with small bowel obstruction. The usage of remedies with anti-adhesive properties improves the results of treating children with bowel obstruction.