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This single-center case series reported outcomes of laparoscopic lysis of adhesions combined with placement of Seprafilm in 19 consecutive patients with chronic, intractable abdominal pain attributed to intraabdominal adhesions, excluding patients whose pain was due to irritable bowel syndrome, hernias, or endometriosis. Across 1998–2001, 16 procedures were completed laparoscopically and 3 required conversion due to dense adhesions; complications included two enterocutaneous fistulae and one intraabdominal hematoma. At a mean follow-up of 9.6 months, 73.7% discontinued all pain medications, with 12 patients completely symptom free at the time of writing, while 3 patients were readmitted with small bowel obstruction and managed nonoperatively. The study is limited by its small sample size and lack of a comparator group. The paper excludes endometriosis and thus does not address it as a treatment target, but it is included in the corpus via explicit exclusion of “endometriosis” among differential causes of the abdominal pain.
Abstract
BACKGROUND: The surgical treatment of patients with chronic abdominal pain resulting from intraabdominal adhesions is controversial. We report our experience with treatment of this challenging patient population using laparoscopic lysis of adhesions (LOA) and placement of Seprafilm (Genzyme, Cambridge, MA, USA).
METHODS: The participants in this study were 19 consecutive patients (2 men and 17 women) who underwent laparoscopic LOA and placement of Seprafilm between July 1998 and July 2001. Patients with abdominal pain resulting from irritable bowel syndrome, hernias, or endometriosis were excluded. The patients had undergone a mean of 6.4 previous abdominal procedures (range, 1-14) and 2.3 previous LOAs (range, 0-10). They had experienced chronic, intractable abdominal pain for at least 4 months (range, 4-180). Eight patients had preoperative obstructive symptoms.
RESULTS: A completely laparoscopic procedure was used to treat 16 patients, whereas the procedure for 3 patients was converted to open surgery because of dense adhesions. Perioperative complications included two patients in whom enterocutaneous fistulae developed and one patient with intraabdominal hematoma. At follow-up (mean, 9.6 months; range, 1-32 months), 14 patients (73.7%) had completely discontinued all pain medications. At this writing, 12 of these patients are completely symptom free. Two patients are taking nonsteroidal antiinflammatory drugs (NSAIDs) as needed, and three patients require round-the-clock narcotics. Three patients were readmitted with small bowel obstruction, which was managed nonoperatively. One patient had diagnostic laparoscopy for recurrent pain 6 months postoperatively, but had no adhesions.
CONCLUSION: Chronic intractable abdominal pain is relieved in most patients via this approach. Repeat laparoscopy in two patients showed no intraabdominal adhesions. Laparoscopic LOA and placement of Seprafilm is an excellent approach to this challenging patient population with symptoms caused by intraabdominal adhesions.
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Background: The surgical treatment of patients with chronic abdominal pain resulting from intraabdominal adhesions is controversial. We report our experience with treatment of this challenging patient population using laparoscopic lysis of adhesions (LOA) and placement of Seprafilm (Genzyme, Cambridge, MA, USA). Methods: The participants in this study were 19 consecutive patients (2 men and 17 women) who underwent laparoscopic LOA and placement of Seprafilm between July 1998 and July 2001. Patients with abdominal pain resulting from irritable bowel syndrome, hernias, or endometriosis were excluded. The patients had undergone a mean of 6.4 previous abdominal procedures (range, 1–14) and 2.3 previous LOAs (range, 0–10). They had experienced chronic, intractable abdominal pain for at least 4 months (range, 4–180). Eight patients had preoperative obstructive symptoms. Results: A completely laparoscopic procedure was used to treat 16 patients, whereas the procedure for 3 patients was converted to open surgery because of dense adhesions. Perioperative complications included two patients in whom enterocutaneous fistulae developed and one patient with intraabdominal hematoma. At follow-up (mean, 9.6 months; range, 1–32 months), 14 patients (73.7%) had completely discontinued all pain medications. At this writing, 12 of these patients are completely symptom free. Two patients are taking nonsteroidal antiinflammatory drugs (NSAIDs) as needed, and three patients require round-the-clock narcotics. Three patients were readmitted with small bowel obstruction, which was managed nonoperatively. One patient had diagnostic laparoscopy for recurrent pain 6 months postoperatively, but had no adhesions. Conclusion: Chronic intractable abdominal pain is relieved in most patients via this approach. Repeat laparoscopy in two patients showed no intraabdominal adhesions. Laparoscopic LOA and placement of Seprafilm is an excellent approach to this challenging patient population with symptoms caused by intraabdominal adhesions.
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Khaitan, L., Scholz, S., Houston, H. et al. Results after laparoscopic lysis of adhesions and placement of seprafilm for intractable abdominal pain . Surg Endosc 17, 247–253 (2003). https://doi.org/10.1007/s00464-002-8845-3
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DOI: https://doi.org/10.1007/s00464-002-8845-3
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