Laparoscopic vs Open Adhesiolysis for Bowel Obstruction: JAMA Surgery | June 2026

Introduction: Laparoscopic adhesiolysis offers several short-term advantages over open surgery for adhesive small bowel obstruction (ASBO). However, its long-term impact on recurrence, quality of life, and incisional hernia remains uncertain. The LASSO trial provides the first randomized evidence comparing these two approaches.

Why was this study needed?

• Long-term outcomes after laparoscopic adhesiolysis have not been well established.
• Previous studies have largely focused on short-term recovery.
• Whether laparoscopy reduces recurrent bowel obstruction remains unclear.
• Evidence from randomized controlled trials has been lacking.
• Long-term patient-centered outcomes are important when selecting the surgical approach.

Results:

• Recurrence of small bowel obstruction was similar after laparoscopic and open adhesiolysis over 1.5 years of follow-up.
• Quality of life and incisional hernia rates did not differ between the two surgical approaches.
• The study found no long-term advantage of laparoscopy over open adhesiolysis.

Clinical Impact:

While laparoscopy may still provide short-term benefits in carefully selected patients, surgeons should not expect improved long-term outcomes regarding recurrence, quality of life, or incisional hernia. The choice of approach should therefore be guided by patient characteristics, surgeon expertise, and intraoperative findings.

Bottom Line:

The LASSO trial—the first randomized study in this field—demonstrates that laparoscopic adhesiolysis offers no significant long-term advantage over open surgery for adhesive small bowel obstruction. Short-term benefits remain important, but long-term outcomes are comparable.