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A Prospective Analysis of Predictive Factors on the Results of Laparoscopic Adhesiolysis in Patients with Chronic Abdominal Pain

Swank, Dingeman J. MD; van Erp, Willem F. M. MD, PhD; Repelaer van Driel, Ocker J. MD, PhD; Hop, Wim C. J. MSc, PhD; Bonjer, H. Jaap MD, PhD; Jeekel, Hans MD, PhD

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques: April 2003 - Volume 13 - Issue 2 - p 88-94
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Laparoscopic adhesiolysis for chronic abdominal pain is subject for criticism. In this prospective study, we analyze factors that encourage or discourage the indication for therapeutic laparoscopic adhesiolysis. Two hundred twenty-four consecutive patients with chronic abdominal pain underwent diagnostic laparoscopy, and in case of adhesions, they underwent adhesiolysis. Pain relief was assessed, and the individual impact of variables on pain relief was determined. Laparoscopy was performed in 224 patients. Two hundred patients had only adhesions and underwent primary laparoscopic adhesiolysis. Three months after adhesiolysis, 74% of patients were pain-free or had less pain. The remaining 26% of the patients felt no change (22%) or had more pain (4%). Gender, age, and bowel perforation leading to a laparotomy appear to be individual factors significantly influencing pain relief. Laparoscopic adhesiolysis can be done (almost) completely in 92% of patients with adhesions. After laparoscopic adhesiolysis, 74% of patients had good results and 4% had more pain. The complication rate is high.

From the Department of Surgery, Groene Hart Hospital (DJS), Gouda; the Department of Surgery, Máxima Medical Center (WFMvE, OJRvD), Eindhoven; and the Departments of Epidemiology & Biostatistics (WCJH) and Surgery (HJB, HJ), Erasmus University Medical Center, Rotterdam, The Netherlands.

Received April 24, 2002;

revision received November 11, 2002; accepted December 2, 2002.

Address correspondence and reprint requests to Dr. Dingeman J. Swank, Kalmoes 10, 2811 EB Reeuwijk, The Netherlands. Address electronic mail to djswank@xs4all.nl

© 2003 Lippincott Williams & Wilkins, Inc.