Trial Comparing Early Laparoscopic Enterolysis Versus Nonoperative Management for High-grade SBO

Launched by YALE UNIVERSITY · Feb 22, 2016

Keywords

ClinConnect Summary

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 questi...

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Eligibility criteria

• 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