Trial Comparing Early Laparoscopic Enterolysis Versus Nonoperative Management for High-grade SBO
Trial Comparing Early Laparoscopic Enterolysis Versus Nonoperative Management for High-grade SBO
The goal is to assess the appropriateness of the standard practice of a trial of nonoperative
 management for high grade small bowel obstruction (currently up to 72 hours based on
 available literature). The investigator will offer early laparoscopic enterolysis (within 24
 hours of admission) as the comparator group.
Small bowel obstruction is a common disorder without a clearly superior management strategy.
 There are an estimated 300,000 surgeries performed annually with a health care expenditure
 burden in excess of 2.8 billion dollars. The investigators propose a new management paradigm
 including early laparoscopic management.

 Contemporary management of SBO includes a trial of nonoperative management (TNOM) reportedly
 with resolution in upwards of 70% of patients.

 Although it is one of the most common diagnosis for surgical admissions, there are few
 prospective, clinical trials to address the question surgical timing. Additionally, there are
 no prospective, randomized trials comparing early laparoscopy versus TNOM for high grade SBO.
 The hypothesis is that early laparoscopic enterolysis will result in decreased overall
 complications, shorter length of stay, decreased health care cost, and lower conversion rate
 to open laparotomy.
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