Missed Opportunity: Laparoscopic Colorectal Resection Is Associated With Lower Incidence of Small Bowel Obstruction Compared to an Open Approach

Objective: To investigate the effect of a laparoscopic approach on the rate of adhesion-related small bowel obstruction (SBO) following colorectal resection. Background: Currently, there is little compelling evidence with regard to rates of SBO after laparoscopic versus open abdominal surgery. Few studies have compared risk-adjusted rates of SBO following laparoscopic and open colorectal resection. Methods: The Statewide Planning and Research Cooperative System was queried for elective colorectal resections in New York State from 2003 to 2010. A propensity score was calculated to account for selection bias between choice of laparoscopic versus open resection. Bivariate and multivariable competing-risks models were constructed to assess patient, hospital, surgeon, and operative characteristics associated with SBO and operation for SBO within 3 years of resection. Results: Among 69,303 patients who underwent elective colorectal resection (26% laparoscopic, 74% open), 5.3% of patients developed SBO and 2% of patients underwent an operation for SBO. After controlling for other risk factors and conducting an intention-to-treat analysis, open resection was associated with a higher risk of both SBO [hazard ratio (HR) 1.14, 95% confidence interval (CI) 1.03-1.26] and operation for SBO (HR 1.12, 95% CI 0.94-1.32). This effect was even greater when characterizing laparoscopic-to-open conversions as an open approach (SBO: HR 1.34, 95% CI 1.20-1.49; SBO operation: HR 1.35, 95% CI 1.12-1.63). Most other independent risk factors were non-modifiable and included age <60, female sex, black race, higher comorbidity burden, previous surgery, inflammatory bowel disease, and procedure type. Conclusions: Open colorectal resection increases the risk of SBO compared with laparoscopy. Increased utilization of a laparoscopic approach has the potential to achieve a significant reduction in the incidence of SBO following colorectal resection.