Predictors of laparoscopic conversion in the treatment of patients with acute adhesive small bowel obstruction: results of a multicenter retrospective cohort study

Abstract

Endovideosurgery for acute adhesive small bowel obstruction may be associated with a high risk of conversion and iatrogenic bowel injury (up to 26.9 %). However, reliable criteria for selecting patients for laparoscopic access have not yet been established, which necessitates the search for valid predictors of intervention success. Objective – to identify anamnestic, clinical, and instrumental signs indicating a high risk of conversion and the inappropriateness of laparoscopic access in patients with acute adhesive small bowel obstruction. This multicenter retrospective cohort study included 367 patients who underwent attempted laparoscopic adhesiolysis between 2020 and 2025 in seven hospitals of the Russian Federation. The groups of successful laparoscopy (n=199) and access conversion (n=168) were formed. Univariate and multivariate analyses were performed using logistic regression, multiple imputation, and ROC analysis. Conversion was required in 45.8 % of cases. Univariate analysis showed that successful laparoscopy was associated with smaller bowel diameter on plain abdominal radiograph, greater surgeon experience, no prior abdominal surgeries (41.2 % in the laparoscopy group vs. 10.1 % in the conversion group, p<0.001), and the presence of strangulation obstruction (46.2 % vs. 19.0 %, p<0.001). Multivariate regression identified independent predictors of success: surgeon experience (each additional 10 years increased the odds by 37 %), total number of previous operations (each operation decreased the odds by 42.2 %), and the presence of strangulation (OR 2.48; 95 % CI: 1.49–4.13). CT signs of strangulation (hypoperfusion, beak sign, closed loop) were also prognostically significant; however, CT was performed in only 36.7 % of patients, which does not allow formulating any recommendations based on radiological semiotics. The predictors of successful laparoscopy in acute adhesive small bowel obstruction are: a small total number of previous abdominal operations (preferably an unoperated abdomen), extensive surgeon experience, and a reasonable suspicion of strangulation obstruction (which is more often associated with a single adhesion).