- In some adhesive small bowel obstruction cases, laparoscopic bests open adhesiolysis for selected patients in the LASSO trial.
- The advantage for some is a faster recovery, less pain, faster return of function.
- Nevertheless, every fourth laparoscopy required conversion.
Why this matters
- Although laparoscopy might seem obviously tied to faster recovery, some concerns have persisted about whether that balances out relative benefits vs the open approach.
- One increased risk with laparoscopy is iatrogenic injury.
- Editorial notes careful patient selection in this trial and need for long-term data to assess true incidence of adhesion recurrence vs open approach.
- Postoperative length of stay was an average 1.3 days longer with open approach.
- Postop complication rate was 43% with open vs 31% with laparoscopic approach (OR, 0.61; 95% CI, 0.27-1.38; P=.23).
- 1 death in each group.
- Shorter time to bowel function in laparoscopy group.
- International (Finland, Italy), multicenter (5 centers), parallel open-label trial.
- 51 patients had open surgery; 53 had laparoscopy.
- Effort to include only patients with 1 adhesive band; ended up with a third having >1.
- Primary outcome: postoperative length of stay.
- Funding: Foundations, government.
- Small sample size.