title: Twelve-year outcomes of laparoscopic adhesiolysis in patients with chronic abdominal pain: A randomized clinical trial.
abstract: Laparoscopic adhesiolysis as a therapy for chronic pain is still controversial, and long-term effects are not known; therefore, our aim was to evaluate long-term effects of laparoscopic adhesiolysis for the treatment of chronic abdominal pain believed to be related to intraperitoneal adhesions.
  
  
  
  A total of 100 patients with abdominal pain attributed to adhesions were randomized to laparoscopic adhesiolysis or a placebo group with laparoscopy alone. Pain relief was assessed after 12-year follow-up.
  
  
  
  A total of 73% of patients fulfilled the long-term follow-up. Compared to the placebo group (n = 31), patients in the adhesiolysis group (n = 42) were significantly less often pain-free (8 vs 13, P = .033, relative risk [RR] = 1.3) and to have a greater intake of analgesics (26 vs 16, P = .379, RR = 1.2, 95% confidence interval 0.8-1.8). Moreover, the adhesiolysis group sought medical consultations more frequently (14 vs 6, P = .186, RR = 1.33, 95% confidence interval 0.9-1.9), and had an increased rate of additional operation (8 vs 1, P = .042, RR = 1.67, 95% confidence interval 1.208-2.318). Both groups had improved pain and quality-of-life scores.
  
  
  
  This is the first, long-term, placebo-controlled trial regarding the use of laparoscopic adhesiolysis for treating chronic abdominal pain. Laparoscopic adhesiolysis was less beneficial than laparoscopy alone in the long term. Secondly, there appeared to be a powerful, long-lasting placebo effect of laparoscopy. Because adhesiolysis is associated with an increased risk of operative complications, avoiding this treatment may result in less morbidity and health care costs.
authors.affiliation: Department of General Surgery, Groene Hart Hospital, Gouda, The Netherlands; Department of General Surgery, Erasmus Medical Center, Rotterdam, The Netherlands. Electronic address: mjmolegraaf@gmail.com.
authors.forename: Marijke J
authors.initials: MJ
authors.lastname: Molegraaf
authors.affiliation: Department of Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Bart
authors.initials: B
authors.lastname: Torensma
authors.affiliation: Department of General Surgery, Groene Hart Hospital, Gouda, The Netherlands.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Lange
authors.affiliation: Department of General Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Johan F
authors.initials: JF
authors.lastname: Lange
authors.affiliation: Department of Neuroscience, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Johan
authors.initials: J
authors.lastname: Jeekel
authors.affiliation: Department of General Surgery, Groene Hart Hospital, Gouda, The Netherlands.
authors.forename: Dingeman J
authors.initials: DJ
authors.lastname: Swank
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D000328:Adult; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011788:Quality of Life; D018570:Risk Assessment; D013997:Time Factors; D000267:Tissue Adhesions / Q000150:complications* / Q000601:surgery*; D016896:Treatment Outcome