Practice variations in the surgical treatment of small bowel obstruction in Quebec

Abstract

Background: Small bowel obstruction (SBO) is a common emergency and selectively requires surgical management. There is growing evidence supporting the use of laparoscopic surgery (LS) compared to open surgery for SBO. Methods: An online survey-based cohort study examining surgeon characteristics, patient factors, and clinical situations that impact decision making regarding the use of LS for SBO was sent to the 538 members of the Association Québécoise de Chirurgie and their answers were collected over a 4-month period in 2019. Results: The response rate was 27.1% (n=146). The gender, sex or the practice setting did not have an impact on the surgical approach. It was noted that surgeons who were more comfortable with laparoscopy used it more often (P=0.002). The three factors favoring the initial approach by laparotomy were most frequently cited: hostile abdomen, severe abdominal distension, and hemodynamic instability. Young surgeons had more homogenous answers (P=0.03). The surgeons having a practice oriented into LS had different decision criteria compared to those doing more open surgery. Conclusion: This article emphasizes key clinical scenarios and determinants that shape the surgical strategy for SBO treatment. The authors aim for this research to stimulate more discussions and contemplation about using laparoscopic methods for treating SBO in certain patients, thereby potentially elevating the frequency of surgeons adopting this approach. Moreover, considering the existing literature supports LS as a viable and safe method for SBO treatment, and noting the enhanced outcomes for patients, it becomes increasingly vital to advocate for this conversation.