title: Selective laparoscopic adhesiolysis in the management of acute and chronic recurrent adhesive bowel obstruction.
abstract: BACKGROUND
  Laparoscopic adhesiolysis became popular in the last decade for the management of postoperative adhesive small bowel obstruction. This paper investigates the feasibility, effectiveness and safety of laparoscopy in this field; the details of a selective adhesiolysis were discussed as well.
  
  
  METHODS
  The patients who underwent laparoscopic management of acute or chronic recurrent adhesive bowel obstruction were included into the study. The patients were managed according to a specific algorithm. If the conservative management has failed, selective laparoscopic adhesiolysis to the transition zone of distended /collapsed bowel was performed. Patients, who were suffering from chronic recurrent obstruction attacks and those who tolerated oral intake, underwent preoperative enteroclysis studies and selective adhesiolysis was performed according to imaging findings. Computerized tomography was performed in all cases to exclude other diagnoses.
  
  
  RESULTS
  Thirty-one patients (22 female, 9 male) underwent laparoscopic adhesiolysis from January 1998 to June 2007. The mean age was 48 (range: 20-80). Enteroclysis--guided laparoscopic adhesiolysis was performed in nineteen patients. Twelve patients underwent laparoscopic adhesiolysis for acute obstruction. Enteroclysis was able to demonstrate the pathological adhesion or band in all of the patents who underwent this imaging technique. Conversion and complication rates were 9.6%. The entire patients tolerated well oral intake postoperatively except one who had underwent enteroclysis-guided adhesiolysis; the patient presented with transient subileus on postoperative day 34 and responded well to conservative management. Mean hospital stay was 4.1 days (range: 2-7). The patients are free of symptoms on their follow-up.
  
  
  CONCLUSIONS
  Laparoscopy is feasible, safe and effective in postoperative adhesive disease. Laparoscopic adhesiolysis should be performed as selective as possible in acute and chronic cases. Enteroclysis is a helpful imaging modality for performing selective laparoscopic adhesiolysis in chronic obstruction.
authors.affiliation: Department of General Surgery, Istanbul University, Cerrahpaşa Medical Faculty, Istanbul, Turkey. kayasaribeyoglu@gmail.com
authors.forename: Kaya
authors.initials: K
authors.lastname: Saribeyoğlu
authors.forename: Salih
authors.initials: S
authors.lastname: Pekmezci
authors.forename: Uğur
authors.initials: U
authors.lastname: Korman
authors.forename: Ece
authors.initials: E
authors.lastname: Kol
authors.forename: Bilgi
authors.initials: B
authors.lastname: Baca
authors.forename: Semra
authors.initials: S
authors.lastname: Günay
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012008:Recurrence; D000267:Tissue Adhesions / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome