SURGICAL MANAGEMENT OF BOWEL OBSTRUCTION DUE TO ADHESIONS: TRADITIONAL AND MINIMALLY INVASIVE APPROACHES

Abstract

Introduction: Adhesive intestinal obstruction is the leading cause of small bowel obstruction in patients with a history of abdominal surgery, accounting for significant morbidity, recurrence rates, and hospital costs. Adhesion formation stems from the inflammatory and healing response of the peritoneum and can lead to abdominal pain, distension, vomiting, intestinal ischemia, and the need for emergency surgery. While conservative treatment is indicated in selected cases, a surgical approach remains essential when there are signs of strangulation or ischemia, or if clinical management fails. In this context, comparing traditional and minimally invasive techniques is relevant for guiding evidence-based practice. Objective: To analyze scientific evidence regarding the surgical management of adhesive intestinal obstruction, comparing conventional and minimally invasive approaches in terms of clinical outcomes. Methods: This is a narrative literature review based on searches in the PubMed, SciELO, Virtual Health Library (VHL), and Cochrane Library databases. Articles published between 2019 and 2025 in Portuguese and English were selected, along with international guidelines on the management of adhesive intestinal obstruction. Eligible studies underwent qualitative and descriptive analysis. Results: Evidence indicates that laparotomy remains the preferred approach for patients with hemodynamic instability, suspected intestinal necrosis or perforation, or severe abdominal distension. Conversely, laparoscopy has proven safe and effective in selected cases, offering reduced surgical trauma, less postoperative pain, a lower incidence of surgical site infections, faster recovery of bowel function, shorter hospital stays, and reduced formation of new adhesions. However, its performance depends on appropriate patient selection, the surgical team's experience, and the availability of technological resources, given that extensive adhesions increase the risk of inadvertent bowel injury and conversion to open surgery. Conclusion: The surgical management of bowel obstruction due to adhesions must be individualized, taking into account clinical severity, imaging findings, and intraoperative conditions. Minimally invasive surgery offers significant advantages for carefully selected patients, whereas laparotomy remains indispensable in complex cases. The adoption of evidence-based care protocols helps reduce complications, recurrences, and morbidity and mortality, thereby promoting greater safety and quality in surgical care.