Trial Comparing Early Laparoscopic Enterolysis Versus Nonoperative Management for High-grade SBO
Small Bowel Obstruction
About this trial
This is an interventional treatment trial for Small Bowel Obstruction
Eligibility Criteria
Inclusion Criteria:
- CT A/P showing high grade obstruction (all patients will obtain a CT A/P as per Level 1 recommendations based on EAST practice guidelines) .
High grade bowel obstruction is defined as:
- Transition point
- Distal small collapse with proximal dilatation
- Small bowel feces sign
- 50% difference in caliber change between proximal dilated bowel and distal decompressed bowel
- Intra-abdominal free fluid without clinical signs of ischemia
Exclusion Criteria:
- Hemodynamic instability (SBP<90)
- Peritonitis
- Enterocutaneous fistula
- Cirrhosis
- previous enterolysis (more than 1)
- Contraindication to laparoscopic surgery
- Pregnancy
Sites / Locations
- Yale New Haven Hospital
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Early laparoscopic enterolysis
trial of nonoperative management
Patient randomized to the early laparoscopy arm will undergo diagnostic laparoscopy within 24 hours of admission (depending on surgeon and operating room availability). Standard laparoscopy will be performed including supine positioning, sequential compression devices, and appropriate pre-incision antibiotics. Trocar placement will be at the surgeon's discretion and as appropriate for the patient's previous incisions. The necessity for conversion will be left to the discretion of the attending surgeon. Post operative management will conform to the standards of care. Nasogastric tubes will not be routinely placed.
Patients randomized to the trial of nonoperative management arm will undergo standard therapy including nil per os (NPO), nasogastric decompression only if actively vomiting, intravenous fluids while awaiting return of bowel function. Patients who do not achieve return of bowel function within 72 hours of admission will undergo attempted laparoscopic enterolysis with the understanding that conversion to open procedure may be necessary.