Laparoscopic adhesiolysis in patients with chronic abdominal pain.
OBJECTIVE
The purpose of this review was to evaluate the indications, safety, and efficacy of laparoscopic adhesiolysis and its prevention in patients with chronic abdominal pain.


RESULTS
The safety of laparoscopic adhesiolysis can be improved by using an optic trocar for laparoscopy, by using an ultrasonic technique for adhesiolysis, and by taking care with regard to risk factors. Although many studies have reported pain reduction after laparoscopic adhesiolysis, a recent randomized study showed no more pain relief than with diagnostic laparoscopy alone. The regrowth of adhesions after adhesiolysis is less after the laparoscopic technique compared with open surgery. Liquid products can prevent the formation of adhesions, but their clinical efficacy has not yet been proved in randomized studies in humans.


CONCLUSIONS
Older patients with a greater number of previous abdominal operations are more prone to complications in laparoscopic surgery. The introduction of a Veress needle into the ninth intercostal space, the use of an optic trocar and ultrasonic dissection can reduce the incidence of iatrogenic bowel perforations. For chronic pain, diagnostic laparoscopy is encouraged, but laparoscopic adhesiolysis is no longer recommended; its benefit being no greater than that of diagnostic laparoscopy alone.
Swank
Dingeman J
DJ
Department of General Surgery, Groene Hart Hospital, Gouda, the Netherlands. djswank@xs4all.nl
Jeekel
Hans
H
D015746:Abdominal Pain / Q000175:diagnosis / Q000601:surgery*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D011027:Pneumoperitoneum / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D000267:Tissue Adhesions / Q000209:etiology* / Q000601:surgery