Feasibility and safety of laparoscopic small bowel resections with intracorporal anastomosis in emergency settings - a retrospective single centre study.

INTRODUCTION: Minimally invasive surgery (MIS) is increasingly applied in complex abdominal surgery and has been associated with potential benefits compared with the open approach (OS). However, evidence on the feasibility and safety on MIS small bowel resections (SBR) in the emergency setting remains limited. METHODS: The study included patients requiring emergency SBR with primary anastomosis between 01/2020 and 04/2025; data were collected from the hospital information system at a tertiary referral centre. Patient outcomes of MIS vs. open SBR with anastomosis were compared before and after propensity score matching (PSM). RESULTS: Overall, 45 patients with SBR for isolated small bowel pathology were identified, of whom 7 (15.6%) underwent MIS. Of these (3 females, 4 males; median 70, range 29-77 years), six were diagnosed with haemorrhagic small bowel infarction and one with obstructive ileus. Postoperative Comprehensive Complication Index (CCI; median 8.7, range 0-30.8; p = 0.04) and time to first flatus (median 2, range 1-4 days; p = 0.02) were lower after MIS compared to OS. Postoperative diet progression (median 4.5, range 2-7 days) and length of stay (median 6.5 days, range 4-12 days) did not differ (length of stay: p = 0.34, diet progression: p = 0.11). There were no anastomotic leaks or revisional surgeries after MIS. The costs for MIS were lower compared to OS (EUR 5,975 vs. EUR 8,925). There were no group differences after PMS. CONCLUSION: Our data suggest that laparoscopic small bowel resections with intracorporal anastomosis in an emergency setting are feasible and safe in highly selected cases.