Evaluating surgical strategies for small bowel obstruction in virgin abdomen: A comparative analysis of laparoscopic and open approaches

Small bowel obstruction in virgin abdomen (SBO-VA) is rarely encountered and there is no standard treatment strategy. Even though nonoperative management is advocated in recent studies, studies evaluating the outcomes and results of laparoscopic surgery in these patients are lacking. This study aimed to compare the results of laparoscopic and open surgeries in SBO-VA patients. Thirty-five patients, >= 18 years old, who were admitted to the Hacettepe University Faculty of Medicine, General Surgery Department between January 2018 and December 2023 with virgin abdomen intestinal bowel obstruction and underwent open surgery and laparoscopic surgeries, were analyzed retrospectively. The demographic and clinical characteristics of patients were analyzed from hospital records. For 19 patients, laparoscopic surgery was conducted; for 16 patients, open surgery was conducted. Adhesions (60%) were the most common underlying etiology followed by Meckel diverticulum (17.4%). Pathological examination revealed malignancy in 4 (11.43%) patients. The diagnostic accuracy of computed tomography performed preoperatively was calculated as 34.3%. In the laparoscopic surgery group, the length of incision, Clavien-Dindo Classification score, pain score 24 hours after surgery, and length of hospital stay were statistically significantly lower compared with open surgery group (P < .001, P = .01, P < .001, P = .001, respectively). Although it was statistically insignificant, median time to oral intake after surgery was shorter in laparoscopic group when compared with the open surgery group (48 hours [48-72] vs 72 hours [48-72], P = .056). Laparoscopic surgery in SBO-VA seems to be more advantageous than open surgery due to its favorable postoperative outcomes as well as diagnostic and therapeutic effectiveness.