Outcomes of a Laparoscopic-First Approach for a Strangulated Small Bowel Obstruction: A 12-Year Single-Center Experience.

BACKGROUND: Small bowel obstruction (SBO) is a common surgical emergency. The role of laparoscopy in managing its strangulated form is usually not preferred by many surgeons due to technical challenges and concerns about safety. This study aimed to analyze the outcomes of a "laparoscopic-first" policy for patients with suspected strangulated SBO at a single institution. METHODS: We conducted a retrospective review of all patients who underwent a laparoscopic-first approach for suspected strangulated SBO between January 2013 and December 2024. We analyzed the conversion rate to open surgery, intraoperative findings, and postoperative outcomes for patients in whom the laparoscopic procedure was successfully completed. RESULTS: A total of 24 patients underwent a laparoscopic-first approach. Of these, six patients (25.0%) required conversion to open laparotomy, primarily due to difficulty in safely releasing the strangulation or poor visibility. The remaining 18 patients were successfully managed laparoscopically. Within this cohort (median age: 80.0 years), the cause of obstruction was an adhesive band in all cases (100%). Bowel resection, performed extracorporeally via the single-port site in most cases, was required in 16 patients (88.9%). The median operative time was 89 minutes. Postoperative complications (Clavien-Dindo grade ≥ II) occurred in two patients (11.1%). There was no 30-day mortality. The median postoperative hospital stay was 9.5 days. CONCLUSION: A laparoscopic-first approach for selected patients with strangulated SBO is a feasible and safe strategy when performed with a low threshold for conversion. Favorable short-term outcomes with low morbidity can be achieved, even in an elderly cohort requiring a high rate of bowel resection. Prudent patient selection and experienced surgical judgment are paramount to the success of this approach.