Laparoscopic adhesiolysis

Abstract

The aim of this study was the detection of criteria that support the indication for laparoscopic adhesiolysis in patients presenting with unspecific symptoms. A prospective analysis investigates the value of laparoscopic adhesiolysis in patients with chronic abdominal pain after exclusion of other pathologic findings; 58 consecutive patients were followed after laparoscopic adhesiolysis. Endpoints of investigation were extent of adhesions, complications, postoperative hospitalization, and postoperative quality of life. A comparison was drawn to patients following laparoscopic cholecystectomy, laparoscopic cholecystectomy plus adhesiolysis, and conventional cholecystectomy. The results showed that major complications occurred in 10% of cases. In 45% of patients we found a complete remission, in 35% a substantial improvement, and in 20% a persistence of complaints. In a correlation between the preoperative complaints and the extent of adhesions we found small adhesions to cause recurrent abdominal pain without other symptoms while large adhesions produce recurrent abdominal pain in combination with symptoms indicative of intermittent bowel obstruction. Finally, the results of this study indicate a certain "ideal constellation" for an enduring successful adhesiolysis per laparoscopy: it is the subjective complaint of recurrent abdominal pain with a localized and reproducible punctum maximum in combination with a circumscribed area of adhesions at that site.

Functional cine MR imaging for the detection and mapping of intraabdominal adhesions: method and surgical correlation

“…Unequivocal signs and symptoms of bowel obstruction or bowel ischemia present advanced stages of adhesion-related problems [5].…”

“…Thus, an accurate diagnosis of intraabdominal adhesions would be highly valuable [5]. The use of real-time ultrasound (US) to visualize visceral slide for the identification of intraabdominal adhesions has been described by several authors [6,7].…”

Laparoscopic compared with conventional treatment of acute adhesive small bowel obstruction

“…Patients for whom laparoscopy was initially considered to be contraindicated, such as those with a history of previous surgery or with suspected intra-abdominal adhesions or bowel obstruction 2,4,5 , have been treated increasingly with a laparoscopic approach as experience has grown 6,7 .…”

Comparison of Adhesion Formation in Open and Laparoscopic Surgery

“…However, all of them, especially transabdominal ultrasonography, have a poor overall sensitivity (50–60%) and the number of false-positive and false-negative predictions make it unreliable for routine use [10]. The patient’s complaint of recurrent abdominal pain with a localized and reproducible punctum maximum is still the most valuable clinical hint of symptomatic adhesions [11]. Chronic or recurrent abdominal pain with irregular bowel motions, and a history of previous abdominal surgery may be suspicious of symptomatic adhesions, causing entrapment and tension in the peritoneum.…”