The Role of Laparoscopic Adhesiolysis in the Treatment of Patients with Chronic Abdominal Pain or Recurrent Bowel Obstruction

BACKGROUND: Major abdominal operations result in random and unpredictable scar tissue formation. Intraabdominal scar tissue may contribute to recurrent episodes of bowel obstruction, chronic abdominal pain, or both. Laparoscopic adhesiolysis may provide relief of symptoms in patients with prior abdominal surgery with chronic abdominal pain or recurrent bowel obstruction. METHODS: Between September 1996 and April 1999, 35 patients underwent laparoscopic adhesiolysis. Fifteen of the patients had adhesiolysis in conjunction with other major laparoscopic procedures and were excluded from the study. Twenty of the patients who underwent adhesiolysis only were retrospectively assessed for symptomatic relief as well as peri-operative morbidity and mortality. RESULTS: Two of 20 patients were not available for long-term follow-up. In the 18 remaining patients, laparoscopic adhesiolysis was performed on 13 patients with abdominal pain and 5 patients with recurrent bowel obstruction. The follow-up period ranged from 1 to 32 (mean 11) months. Sixteen of the 18 (88.9%) operations were completed laparoscopically. Two operations were converted to open for partial enterectomy. An additional enterotomy was repaired laparoscopically. All 3 operative complications were encountered in patients operated on during hospitalization for active bowel obstruction. No mortalities or blood transfusions occurred. One patient required rehospitalization for nonoperative management of an intraabdominal hematoma. Fourteen of the 18 (77.8%) had subjective improvement in their quality of life after operation. Only 1 patient has required repeat adhesiolysis. CONCLUSIONS: Laparoscopic adhesiolysis is a safe and effective management option for patients with prior abdominal surgery with chronic abdominal pain or recurrent bowel obstruction not attributed to other intraabdominal pathology. Laparoscopic intervention in patients with active bowel obstruction may increase the risk of operative complications.