Minimally Invasive Surgery in Acute Bowel Obstruction: Should It Become the Standard of Care? A Prospective, Single Center, Observational Study

<b>Background/Objectives</b>: This study was conducted to determine whether a structured clinical pathway can help to safely implement minimally invasive surgery (MIS) as the standard approach in surgery for acute bowel obstruction (ABO). <b>Methods</b>: A prospective analysis was performed on consecutive patients undergoing MIS for ABO at a single center in 2021 and 2022. Prior to the study onset, a structured treatment pathway was defined to apply MIS in all patients. The rate of success in the MIS and patient-, surgeon- and outcome-specific parameters with a focus on complication and conversion rates were analyzed. <b>Results</b>: Compared to a historical control group, the conversion rate from MIS to open surgery (OS) nearly doubled from 20.4% to 36.4% (<i>p</i> = 0.14). The complication rate in converted patients was 43.8% vs. 7.15% in non-converted patients (<i>p</i> < 0.05). <b>Conclusions</b>: A structured clinical pathway, including technical standardization and preoperative decisional processes, can be used to implement MIS as a primary surgical treatment in ABO. This is accompanied by high conversion rates and a significant increase in postoperative complications in patients undergoing conversion. Individual decision-making concerning the surgical approach remains paramount to prevent complications and high conversion rates.