Comparative outcomes of multi-port versus single-port laparoscopic surgery in adhesive small bowel obstruction

Nurzhan Klyshbekov, Фурсов А.Б., Roman Fursov, Аружан Боранкулова, B.K. Bae

2026

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DOI 10.1007/s00423-026-04197-x
Data confidence 70 medium
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Abstract

Laparoscopic surgery is increasingly used in the management of adhesive small bowel obstruction (ASBO), offering advantages over open surgery in selected patients. While conventional multi-port laparoscopy is well established, the role of single-port laparoscopic surgery in ASBO remains less clearly defined. This study aimed to compare perioperative outcomes, postoperative recovery, and complications between multi-port and single-port laparoscopic approaches for ASBO. A multicenter non-randomized retrospective cohort study was conducted including 208 patients who underwent laparoscopic surgery for ASBO between 2019 and 2024. Patients were divided into a multi-port laparoscopy group ( n = 97) and a single-port laparoscopy group ( n = 111). Continuous variables were assessed for normality and are presented as median and interquartile range (IQR), with comparisons performed using the Mann–Whitney U test. Categorical variables were compared using the χ² test or Fisher’s exact test, as appropriate. Statistical analysis was performed using Stata MP version 18.0. Baseline demographic and clinical characteristics were comparable between groups. Median operative time was significantly shorter in the single-port group (135 [120–150] vs. 145 [132–160] minutes, p = 0.007), and estimated blood loss was significantly lower (45 [30–65] vs. 80 [50–110] mL, p < 0.001). Postoperative recovery favored single-port laparoscopy, with earlier resumption of oral intake (3 [2–4] vs. 5 [4–7] days, p < 0.001), faster ambulation (2 [2–3] vs. 3 [3–4] days, p < 0.001), and shorter length of hospital stay (12 [11–13] vs. 13 [12–14] days, p < 0.001). The overall postoperative complication rate was significantly lower in the single-port group ( \(10.8\%\) vs. \(23.7\%\) , \(p=0.0035\) ), including a reduced incidence of prolonged postoperative ileus (3.0% vs. 12.4%, p = 0.012). Intraoperative conversion from single-port to multiport laparoscopy occurred in 10 patients (9.0%); no conversions to open laparotomy occurred. Transumbilical single-port laparoscopic surgery for adhesive small bowel obstruction is safe and effective in appropriately selected patients. When evaluated under ITT principles and adjusted for disease severity, single-port access provides equivalent 30-day safety while significantly accelerating functional gastrointestinal recovery and reducing hospital stay compared with conventional multiport laparoscopy.