الفهرس 
Introduction
Anatomy of Peritoneum and IntestineOnly 14 pages are availabe for public view
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Abstract
This present study is a prospective randomized comparative clinical trial involving 66 patients with acute adhesive small bowel obstruction admitted at the department of general surgery, Mansoura University, Mansoura, Egypt at the period from October 2017 until December2018.The included cases were divided into two equal groups; group I included 33 cases who underwent laparoscopic exploration, and group II which included the remaining 33 cases who underwent open exploration.All cases were subjected to complete history taking, thorough physical examination, and routine laboratory investigations. Moreover, the study was approved by the local ethical committee. The mean age of the included cases was 47.1 and 45.6 years for the laparoscopic and open groups respectively. In the laparoscopic group, males (63.6%) and females (36.4%) were included, whereas males (57.6%) and females (42.4%) were included. No significant difference was detected between the study groups regarding preexisting medical comorbidities. Moreover, the history of previous surgical operations did not differ significantly between the two groups (p = 0.236). The commonest operation encountered was appendectomy), followed by cesarean section. Accordingly, Incision type did not differ between the two study groups. Operative time was significantly reduced in the laparoscopic group when compared to open cases (102.16 vs. 129.27 minutes – p = 0.001). Single band obstruction was commonly detected in the laparoscopic group (18 cases – 54.5%), while complex adhesions were encountered more commonly in the open group (22 cases – 66.7%) (p = 0.001). Intraoperative injuries were encountered in 6 cases (18.2%) in the laparoscopic group, whereas it was encountered in 7 cases (21.21%) in the open group (p = 0.437). On exploration, intestinal loop suspected to be gangrenous was detected in only 1 case in both groups (p = 1). Conversion to open technique was performed in 11 cases in the laparoscopic group (33.3%). Six cases were converted due to bowel injury, while another two cases were converted due to bleeding. Impossible dissection prevented laparoscopic completion in one case. The remaining two cases were the two having suspicious gangrenous loops. The laparoscopic group experienced significantly less post-operative pain according to VAS score (p = 0.001). Moreover, shorter hospital stay was noticed in the laparoscopic group (2 vs. 5 days – p = 0.015). However, passage of motion did not differ between the two study groups (p = 0.067). Post-operative wound infection was significantly higher in the open group (13 vs. 1 cases – p < 0.001). Surgical site hernia was also more noticed in the open group during follow up (17 vs. 3 cases – p < 0.001). Recurrent adhesive obstruction was experienced in 2 cases (9.09%) in the laparoscopic group and 5 cases (11.36%) in the open group (p = 0.673).