LASSO: laparoscopic bests open adhesiolysis in some adhesive small bowel obstruction

  • Lancet Gastroenterol Hepatol

  • curated by Emily Willingham, PhD
  • Clinical Essentials
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • 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.

Key results

  • 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.

Study design

  • 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.

Limitations

  • Small sample size.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit