# Long-Term Outcomes After Laparoscopic vs Open Adhesiolysis for Small Bowel Obstruction: The LASSO Randomized Clinical Trial

## TL;DR

A study compared laparoscopic and open surgery for small bowel obstruction and found no long-term benefits for laparoscopic surgery in terms of recurrence or quality of life.

## Contribution

This study provides evidence that laparoscopic surgery does not offer long-term advantages over open surgery for adhesive small bowel obstruction.

## Key findings

- Laparoscopic surgery did not reduce small bowel obstruction recurrence rates compared to open surgery over 5 years.
- Quality of life and incisional hernia rates were similar between laparoscopic and open surgery groups.
- Short-term benefits of laparoscopic surgery do not translate to long-term advantages.

## Abstract

This prespecified analysis of the Laparoscopic vs Open Adhesiolysis for Adhesive Small Bowel Obstruction (LASSO) randomized clinical trial investigates if laparoscopic surgery for adhesive small bowel obstruction decreases small bowel obstruction recurrence rate or incidence of incisional hernias and improves the long-term quality of life compared with open surgery.

Does laparoscopic surgery for adhesive small bowel obstruction decrease small bowel obstruction recurrence rate or incidence of incisional hernias and improve the long-term quality of life compared with open surgery?

In this prespecified analysis of the Laparoscopic vs Open Adhesiolysis for Adhesive Small Bowel Obstruction (LASSO) randomized clinical trial including 100 participants, laparoscopy was not found to be superior to open surgery in terms of small bowel obstruction recurrence rate, incisional hernia incidence, or quality of life in 5-year follow-up.

Results suggest that open surgery is still a good option for the treatment of adhesive small bowel obstruction as long-term outcomes are similar to those of the laparoscopic approach; laparoscopy is a treatment alternative option for highly select patients due to short-term benefits.

A laparoscopic approach for adhesive small bowel obstruction (SBO) requiring surgery provides quicker recovery compared with open surgery, but benefits in long-term follow-up are unclear.

To compare SBO recurrence, incisional hernia, and quality of life (QOL) outcomes in long-term follow-up after laparoscopic vs open surgery.

The Laparoscopic vs Open Adhesiolysis for Adhesive Small Bowel Obstruction (LASSO) randomized clinical trial was conducted in 8 hospitals in Finland and Italy between July 2013 and April 2018. In this study, the 5-year follow-up is reported. This was an international, multicenter, parallel, open-label randomized clinical trial including patients with clinical and radiological signs of adhesive SBO not resolving by conservative means. Study data were analyzed from February to May 2025.

Open vs laparoscopic adhesiolysis.

SBO recurrence rate, incisional hernia incidence and QOL (Gastrointestinal Quality Of Life Index [GIQLI] and 36-item Short-Form Health Survey [SF-36]) within 5 years are reported using modified intention-to-treat and post hoc per-protocol analyses.

A total of 104 patients were randomized, and 100 (mean [SD] age, 69.2 [15.7] years; 65 female [65%]) were included in the analyses (49 in open surgery, 51 in laparoscopic surgery). At 1 year, 1 patient (2.3%) in the open-surgery group had recurrent SBO vs 2 patients (4.5%) in the laparoscopy group (odds ratio [OR], 2.05; 95% CI, 0.18-23.44; P >.99). Within 5 years, 3 patients (9.7%) in the open-surgery group had at least 1 recurrent SBO vs 4 patients (12.5%) in the laparoscopy group (OR, 1.33; 95% CI, 0.27-6.51; P >.99). Incisional hernias were detected in 2 patients (6.1%) in the open-surgery group vs 2 patients (6.3%) in the laparoscopy group (OR, 1.03; 95% CI, 0.14-7.82; P >.99). At 5-year follow-up, median (IQR) SF-36 score was 73.2 (52.8-85.9) in the open-surgery group and 67.1 (42.6-76.7) in the laparoscopy group (P = .23), and median (IQR) GIQLI scores were 118 (95-136) in the open-surgery group and 119 (102-129) in the laparoscopy group (P = .54).

Results of this randomized clinical trial reveal that, although the laparoscopic approach to adhesive SBO has small short-term benefits, it was not superior to open surgery based on long-term follow-up.

ClinicalTrials.gov Identifier: NCT01867528