Predictors of Laparoscopy Conversion in Adhesive Small Bowel Obstruction

January 10, 2026 updated by: Kotkov Pavel, Almazov National Medical Research Centre

Predictors of Laparoscopy Conversion in the Treatment of Adhesive Small Bowel Obstruction

The goal of this observational study is to reveal predictors of unsuccessfull laparoscopic intervention in adult patients with adhesive small bowel obstruction. The main question it aims to answer is: are there any strong predictors of laparoscopy conversion in patients with small bowel obstruction, caused by intraabdominal adhesions.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Considering the undeniable advantages of laparoscopic interventions over laparotomic ones, the question of choosing a surgical approach in patients with acute adhesive intestinal obstruction can be reformulated as follows: in what situations is endovideosurgical intervention generally appropriate and feasible? A laparoscopic approach to severely distended bowel loops and widespread adhesions may increase the risk of serious complications. Indeed, some authors report intestinal injury in 6.3-26.9% of patients undergoing laparoscopic adhesiolysis for acute adhesive intestinal obstruction, which is statistically significantly higher than the same rate in patients operated on using a traditional approach. Therefore, a priority should be addressing the issue of adequately selecting patients who, based on a number of clinical indicators, are suitable for laparoscopic surgery or, at least, have no contraindications. While some parameters, such as acute cardiovascular or respiratory failure and pregnancy in the third trimester, can be defined as absolute contraindications to endovideosurgical access, a number of clinical and instrumental indicators are debatable. Despite the fact that this issue has been extensively covered in the literature, and the list of predictors of unsuccessful laparoscopic adhesiolysis is currently quite impressive, a standardized approach to access selection is lacking or is determined largely intuitively.

The aim of this work is to determine reliable anamnestic, clinical and instrumental signs that would indicate a high risk of conversion of the laparoscopic intervention in patients with acute adhesive intestinal obstruction.

The study is planned to be a multicenter, retrospective case-control study. Clinical data will be collected at four medical institutions in St. Petersburg. The medical records of patients who underwent emergency and urgent surgery for acute adhesive intestinal obstruction will be analyzed.

Study Type

Observational

Enrollment (Estimated)

170

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • Russia
      • Kazan', Russia
        • Kazan Federal University
        • Contact:
      • Perm, Russia
        • City Clinical Hospital No. 4
        • Contact:
      • Saint Petersburg, Russia
        • Almazov National Medical Research Centre
        • Contact:
      • Saint Petersburg, Russia
      • Saint Petersburg, Russia
        • Saint-Petersburg I.I. Dzhanelidze research institute of emergency medicine
        • Contact:
      • Saint Petersburg, Russia
        • The City Hospital of the Holy Martyr Elizabeth
        • Contact:
      • Yekaterinburg, Russia
        • City Clinical Hospital No. 40
        • Contact:
          • Evgenii V Nishnevich, MD
          • Phone Number: +73432436300
          • Email: usma@usma.ru

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

Patients, operated in surgical departments of 4 different hospitals in Saint-Petersburg and one hospital in Perm, Kazan and Yekaterinburg respectively.

Description

Inclusion Criteria:

  • patients underwent emergency and urgent surgery for acute adhesive intestinal obstruction
  • the surgery was performed laparoscopically
  • the surgery was initiated laparoscopically and completed via laparotomy

Exclusion Criteria:

  • acute adhesive intestinal obstruction in the hernial sac
  • pregnant in the third trimester
  • patients with severe cardiovascular or respiratory failure
  • patients with hemodynamic shock

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Laparoscopy group
Patients with acute adhesive intestinal obstruction, operated through surgical intervention, that was initiated and completed using endovideosurgical methods.
Procedure: Laparoscopic adhesiolysis
Dissection of intra-abdominal adhesions performed laparoscopically in accordance with the principles adopted in the medical institution.
Conversion group
Patients with acute adhesive intestinal obstruction, in whom surgical intervention was initiated by endovideosurgical means, however, during the operation there was a need for laparotomy and the surgical procedure was completed by laparotomy access.
Procedure: Laparotomic adhesiolysis
Traditional adhesiolysis, performed via laparotomy after unsuccessfull attempt of endovideosurgical approach.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Rate of succesfull laparoscopic interventions
Time Frame: At the discharge from the hospital (assessed up to 10 days)
The ratio of successful laparoscopic interventions to the total number of operations
At the discharge from the hospital (assessed up to 10 days)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Diameter of intestinal loops
Time Frame: Perioperative
Diameter of intestinal loops (cm), ascertained during X-ray treatment before the operation. The correlation between this outcome and the likelihood of unsuccessful laparoscopic adhesiolysis and the need for laparotomy will be studied. The power of corellation will be measured according to the Spearman correlation coefficient and relative risk with a 95% confidence interval.
Perioperative
Known or suspected complex adhesive process
Time Frame: Perioperative
Presence of known or suspected complex adhesive process (according to anamnestic data). The correlation between this outcome and the likelihood of unsuccessful laparoscopic adhesiolysis and the need for laparotomy will be studied. The power of corellation will be measured according to the Spearman correlation coefficient and relative risk with a 95% confidence interval.
Perioperative
Number of laparotomy operations
Time Frame: Perioperative
Number of laparotomy operations according to anamnestic data. The correlation between this outcome and the likelihood of unsuccessful laparoscopic adhesiolysis and the need for laparotomy will be studied. The power of corellation will be measured according to the Spearman correlation coefficient and relative risk with a 95% confidence interval.
Perioperative
Ischemia or necrosis of the intestine
Time Frame: Perioperative
Ischemia or necrosis of the intestine, requiring resection (diagnosed intraoperatively). The correlation between this outcome and the likelihood of unsuccessful laparoscopic adhesiolysis and the need for laparotomy will be studied. The power of corellation will be measured according to the Spearman correlation coefficient and relative risk with a 95% confidence interval.
Perioperative
Obstruction level
Time Frame: Perioperative
Obstruction level measured in cm from Treitz ligament to obstruction site, diagnosed intraoperatively. The correlation between this outcome and the likelihood of unsuccessful laparoscopic adhesiolysis and the need for laparotomy will be studied. The power of corellation will be measured according to the Spearman correlation coefficient and relative risk with a 95% confidence interval.
Perioperative
Duration of acute intestinal obstruction
Time Frame: Perioperative
Duration of acute intestinal obstruction, measured in hours from pain onset till surgery. The correlation between this outcome and the likelihood of unsuccessful laparoscopic adhesiolysis and the need for laparotomy will be studied. The power of corellation will be measured according to the Spearman correlation coefficient and relative risk with a 95% confidence interval.
Perioperative
Time of day at the start of the surgical intervention
Time Frame: Perioperative
Time of day at the start of the surgical intervention, specified as daytime (from 9:00 to 18:00), evening (from 18:00 to 24:00), night (from 24:00 to 9:00). The correlation between this outcome and the likelihood of unsuccessful laparoscopic adhesiolysis and the need for laparotomy will be studied. The power of corellation will be measured according to the Spearman correlation coefficient and relative risk with a 95% confidence interval.
Perioperative

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Almazov National Medical Research Centre

Investigators

  • Principal Investigator: Pavel А Kotkov, MD, Almazov National Medical Research Centre

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

January 1, 2026

Primary Completion (Estimated)

April 30, 2026

Study Completion (Estimated)

May 31, 2026

Study Registration Dates

First Submitted

December 23, 2025

First Submitted That Met QC Criteria

January 10, 2026

First Posted (Actual)

January 20, 2026

Study Record Updates

Last Update Posted (Actual)

January 20, 2026

Last Update Submitted That Met QC Criteria

January 10, 2026

Last Verified

January 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • 14071979

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Clinical Trials on Adhesive Small Bowel Obstruction

Clinical Trials on Laparoscopic adhesiolysis

Search Similar Trials

Sponsors and Collaborators

Medical Conditions

Drug Interventions

CROs by country

CROs in Cameroon

Conditions

Rare Diseases

Drug Interventions

Dietary Supplements

Sponsor/Collaborators

Locations

Subscribe