Operative Laparoscopy for the Treatment of Localized Chronic Pelvic–Abdominal Pain Caused by Postoperative Adhesions

Fayez, Jamil A.; Clark, Roy R.

doi:10.1089/gyn.1994.10.79

Cited by 19 publications

(6 citation statements)

References 4 publications

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“…In 29 patients, adhesions were found to be the cause of the pain, 24 of whom underwent concomitant adhesiolysis with resultant resolution of the symptoms. Fayez and Clark 19 had the same results in 156 patients presenting with chronic abdominal pain following surgery, and several other retrospective studies concur with these findings. 20,21 New Directions…”

Section: Resultssupporting

confidence: 57%

Laparoscopic Management of Bowel Obstruction

Pikarsky¹,

Reissman²

2004

Laparoscopic Surgery of the Abdomen

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Although some progress in laboratory and imaging studies has been made, the management of intestinal obstruction is still a challenge for the surgeon. Depending on the etiology, intestinal obstruction may be treated conservatively or surgically. As adhesions from previous abdominal surgery are the leading cause of intestinal obstruction, 1 conservative treatment is always attempted first, but any signs or symptoms of bowel ischemia require immediate surgical intervention. In many ways, the wisdom of the adage "never let the sun set on a bowel obstruction" remains the safest guideline whenever any uncertainty exists. Prompt recognition of the need for operative intervention when indicated remains the key to successful management of bowel obstruction.During the past two decades, few major advances have been made in the management of bowel obstruction, and most surgeons continue to rely on clinical criteria as well as laboratory and radiographic findings to determine if and when to operate on these patients. The most common causes for most cases of small bowel obstruction (SBO) eventually requiring operative intervention are adhesions, followed by hernias and neoplasms.2 Combined, these etiologies account for 70% to 80% of all cases. When discussing large bowel obstruction (LBO), one must also consider volvulus of the sigmoid and colonic pseudoobstruction, Ogilvie's syndrome.3 At least 50% of surgical cases are directly related to postoperative adhesions. In these cases, initial nonoperative management is acceptable, with success rates ranging from 50% to 85%. Aggressive, early surgical intervention to avoid ischemic bowel must be balanced against the significant morbidity (30%) and even mortality of such an undertaking. Specifically, previous abdominal surgery and suspected intestinal adhesions along with dilated bowel were initially considered a contraindication to laparoscopy because of the risk of bowel injury and limited visualization. 4 However, both increased surgical experience and improved surgical instrumentation have facilitated a change in opinion to include bowel obstruction as a potential indication for laparoscopic surgery. 5Diagnostic laparoscopy can help avoid laparotomy and allow therapeutic laparoscopy in suitable cases. Laparoscopy in the setting of bowel obstruction does, however, pose certain hazards to the patient. The dilated bowel increases the risk of bowel injury at the entry site, especially at the first entry port. Manipulating friable, edematous bowel may cause bowel injury and perforation. Manipulation of gangrenous bowel without rapid vascular control may lead to endotoxic sepsis. These problems can be limited by using an open-first trocar insertion technique and by handling the bowel loops gently.Another concern related to the laparoscopic technique is the effect of pneumoperitoneum on mesenteric blood flow. Kleinhaus 6 studied the effect of CO 2 insufflation at different intraperitoneal pressures on mesenteric blood flow in dogs. Mesenteric blood flow was reduced to 70% of baseline ...

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Section: Resultssupporting

confidence: 57%

Laparoscopic Management of Bowel Obstruction

Pikarsky¹,

Reissman²

2004

Laparoscopic Surgery of the Abdomen

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“…The severity of adhesions also was less in the laparoscopic group (Table 2) than in either the open control group (13% grade 1, 42% grade 2, 35% grade 3) or the open GHA/CMC membrane group (24% grade 1, 33% grade 2, 10% grade 3). This demonstrates significantly fewer postoperative abdominal wall adhesions after laparoscopic IPAA surgery than after open IPAA surgery with and without the use of this agent.…”

Section: Discussionmentioning

confidence: 89%

“…Adhesions are considered responsible for more than 75% of small bowel obstructions [2]. Postoperative pelvic adhesions to adnexal organs are a major cause of secondary infertility and may be associated with chronic pain [3].A survey of the impact that ulcerative colitis and ilealpouch anal anastomosis (IPAA) has on female reproductive ability found that women with ulcerative colitis managed medically had normal fertility, but that IPAA surgery significantly decreased fertility. The authors of this study suggested that this issue should be discussed with patients considering IPAA surgery [4].…”

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confidence: 99%

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Laparoscopic ileal pouch–anal anastomosis reduces abdominal and pelvic adhesions

2008

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“…In a more recent study, among 52 patients who underwent laparoscopy for chronic abdominal pain, 77% of patients with suspected adhesive disease experienced complete or partial pain relief following adhesiolysis, and there were no operative complications [21] . Despite these and other encouraging studies [22] , [23] , [24] , [25] , others have had disappointing findings [26] , which could possibly be a reflection of patient selection and the amenability of the adhesions to surgical treatment.…”

Section: Surgical Intervention For Adhesive Diseasementioning

confidence: 98%

Abdominal adhesions: A practical review of an often overlooked entity

Tabibian

Swehli

Boyd

et al. 2017

Annals of Medicine &Amp; Surgery

146

103

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Formation of intra-abdominal adhesions is a common consequence of abdomino-pelvic surgery, radiation therapy, and inflammatory processes. In a small but clinically significant proportion of patients, adhesive disease may develop, wherein adhesions lead to a variety of chronic symptoms such as abdominal distension, pain, nausea, and abnormal bowel movement pattern which can be daily, intermittent, or episodic. Due to the chronic and troublesome nature of these symptoms, adhesive disease may be life-altering in many patients, particularly when not recognized and appropriately addressed, as is the case not infrequently. In addition, there is a paucity of literature regarding the evaluation and management of patients with suspected abdominal adhesive disease. Therefore, in this concise review, we provide a clinically practical synopsis of the etiopathogenesis, symptoms, differential diagnosis, evaluation, and treatment of abdominal adhesive disease.

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Operative Laparoscopy for the Treatment of Localized Chronic Pelvic–Abdominal Pain Caused by Postoperative Adhesions

Cited by 19 publications

References 4 publications

Laparoscopic Management of Bowel Obstruction

Laparoscopic Management of Bowel Obstruction

Laparoscopic ileal pouch–anal anastomosis reduces abdominal and pelvic adhesions

Abdominal adhesions: A practical review of an often overlooked entity

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