TOPLINE:

The 5-year recurrence rates, incidence of incisional hernias, and quality-of-life outcomes did not differ significantly between patients with adhesive small-bowel obstruction (SBO) who underwent laparoscopic vs open adhesiolysis. 

METHODOLOGY:

• The LASSO trial was the first and only randomized clinical trial to compare laparoscopic and open adhesiolysis for treating adhesive SBO in terms of length of postoperative hospital stay and morbidity; in selected patients, laparoscopy produced faster recovery with no difference in short‑term complications.
• Researchers evaluated the 5‑year follow‑up outcomes of the LASSO trial to compare long‑term results after laparoscopic vs open surgery.
• They analyzed data of 100 patients (mean age, 69.2 years; 65% women) with clinical and radiologic signs of acute adhesive SBO that did not resolve by nonoperative treatment; patients were randomly assigned to undergo either open (n = 49) or laparoscopic (n = 51) adhesiolysis.
• Outcomes assessed within 5 years included the rate of SBO recurrence, incidence of incisional hernias, and quality of life.

TAKEAWAY:

• Over 5 years, 9.7% of patients in the open surgery group had at least one episode of recurrent SBO compared with 12.5% in the laparoscopy group, but the difference was not statistically significant.
• The 5-year incidence of incisional hernias was also similar in the open surgery and laparoscopy groups (6.1% vs 6.3%), with no statistically significant difference.
• During 5 years of follow-up, quality-of-life scores did not differ significantly between patients who underwent laparoscopic surgery and those who underwent open surgery.

IN PRACTICE:

“This prespecified analysis of the LASSO randomized clinical trial highlights the fact that open surgery is still an option to manage SBO in patients, as long-term outcomes were not worse in open adhesiolysis compared with the laparoscopic approach,” the authors of the study wrote.

“The LASSO trial highlights the importance of individualized surgeon judgment rather than broad generalizations. Surgeons should weigh operative risk, patient characteristics, and their own experience to feel supported in choosing the method with which they are most confident and proficient,” experts wrote in an editorial related to the study.

SOURCE:

The study was led by Panu Räty, MD, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. It was published online in JAMA Surgery.

LIMITATIONS:

The small sample size was a notable limitation of this study. Types of previous surgeries or incisions were not specified. The 5-year recruitment period was long.

DISCLOSURES:

The LASSO trial received funding from the Vatsatautien Tutkimussäätiö Foundation, the Mary and Georg C. Ehrnrooth Foundation, the Martti I. Turunen Foundation, and Helsinki University Hospital research grants. Some authors declared receiving grants from three of the funding agencies during the conduct of the study. One author reported receiving personal fees from a healthcare company outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.