What does this research mean for the field?

Laparoscopic adhesiolysis for adhesive small bowel obstruction is not superior to open surgery in terms of long-term outcomes, including recurrence rates, incisional hernia incidence, and quality of life. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The aim is to compare the long-term outcomes of SBO recurrence, hernia incidence, and quality of life between laparoscopic and open surgical approaches.

February 20, 2026

Long-Term Outcomes After Laparoscopic vs Open Adhesiolysis for Small Bowel Obstruction

Key Points

The aim is to compare the long-term outcomes of SBO recurrence, hernia incidence, and quality of life between laparoscopic and open surgical approaches.
Multicenter, randomized clinical trial conducted in 8 hospitals across Finland and Italy.
Participants included patients with adhesive SBO who did not improve with conservative treatment.
Interventions involved laparoscopic adhesiolysis compared to open adhesiolysis.
Follow-up evaluated SBO recurrence rates, incisional hernias, and quality of life scores over 5 years.
1-year recurrence was 2.3% for open surgery and 4.5% for laparoscopy, with no significant difference.
At 5 years, recurrence rates were 9.7% for open vs 12.5% for laparoscopy.
Incisional hernia occurrence was 6.1% in open surgery vs 6.3% in laparoscopic group, showing no significant difference.
Quality of life scores (SF-36 and GIQLI) were comparable between both groups at 5-year follow-up.

Abstract

Importance 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. Objective To compare SBO recurrence, incisional hernia, and quality of life (QOL) outcomes in long-term follow-up after laparoscopic vs open surgery. Design, Setting, and Participants 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. Interventions Open vs laparoscopic adhesiolysis. Main Outcomes and Measures 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. Results 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 gt;.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 gt;.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 gt;.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). Conclusions and Relevance 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. Trial Registration ClinicalTrials.gov Identifier: NCT01867528

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