diagnostic laparoscopy is often used to identify specific intraabdominal pathology as the cause for chronic abdominal and pelvic pain .
however , few studies have determined that laparoscopic adhesiolysis , as the only operative intervention , ameliorates a significant amount of chronic abdominal pain .
furthermore , only anecdotal reports of the role of laparoscopic adhesiolysis in the setting of acute or chronic bowel obstruction have been published .
our study was designed to investigate the role of laparoscopic adhesiolysis in the treatment of patients with chronic abdominal pain or recurrent bowel obstruction , not attributed to other obvious pathology .
between september 1996 and april 1999 , hospital records of 35 patients who underwent laparoscopic adhesiolysis were retrospectively reviewed .
fifteen patients , who had other major abdominal procedures in conjunction with adhesiolysis , were excluded from the study .
these procedures included cholecystectomy ( 7 ) , repair of incisional hernia ( 2 ) , appendectomy ( 2 ) , gastrostomy ( 2 ) , colon resection ( 1 ) , and nissen fundoplication ( 1 ) .
the extensive adhesiolysis in these 15 patients who were operated on for other specific pathologies was considered incidental .
therefore , these patients were excluded from our study . after obtaining approval from the institutional review board
assessment of symptomatic relief was determined by the questionnaire , and peri - operative morbidity and mortality were assessed by reviewing the inpatient and outpatient charts as well as through the review of the responses to the questionnaires .
of the 20 patients who underwent adhesiolysis only , 2 patients were lost to follow - up .
patients comprised 17 females and 1 male , with a mean age of 52 years ( range 35 to 78 ) .
all operations were completed by 1 surgeon experienced in laparoscopy , at a major medical institution under general anesthesia .
thirteen operations were undertaken for chronic abdominal / pelvic pain , and 5 for bowel obstruction .
of the 5 patients with bowel obstruction , 3 were hospitalized with acute bowel obstruction ; and 2 were operated on electively for treatment of chronic , intermittent bowel obstruction .
the average number of previous abdominal procedures was 2.6 ( range 1 - 4 ; table 1 ) .
preoperatively , patients were worked up extensively with a combination of computerized tomography of the abdomen and pelvis , upper and lower gastrointestinal contrast studies , and upper and lower gastrointestinal endoscopies .
these studies were obtained to rule out obvious intraabdominal / visceral pathology that would explain the patient 's chronic abdominal pain , intestinal obstruction , or both .
only when all studies were considered negative for such processes were the patients considered for laparoscopy and adhesiolysis .
prior abdominal / pelvic surgeries preoperative evaluation postoperatively , 14 of the 18 patients had complete resolution of their symptoms , and an additional 2 patients had partial resolution of their symptoms ( overall 88.9% response to adhesiolysis ) .
seven of these 16 patients reported recurrence of some of their symptoms from 1 week to 6 months following their adhesiolysis .
after a mean follow - up period of 11 months ( range 1  32 months ) , overall , 14 patients ( 77.8% ) reported an improvement in their quality of life and responded that they would have the adhesiolysis again . three patients continue to require intermittent use of medications for pain control . of the 18 operations performed , 3 resulted in enterotomies , 2 of which required conversion to laparotomy for resection of devitalized bowel .
the 3 enterotomies were encountered in the 3 patients hospitalized preoperatively with acute bowel obstruction .
the 15 patients who did not suffer enterotomies were all discharged within 24 hours after their operations .
the remaining 3 patients were discharged from 10 days to 21 days following their operations .
another patient who required laparotomy for bowel resection underwent a subsequent laparotomy for recurrent bowel obstruction .
six other patients have been hospitalized for unrelated medical and surgical conditions ( table 3 ) .
intestinal obstruction is commonly attributed to intraabdominal scar tissue , a claim that is frequently substantiated by operative findings in patients requiring surgical intervention .
abdominal and pelvic pain in association with intraabdominal scar tissue are not as well understood .
mueller and kresch have suggested that adhesions can be the cause of pain if they limit the movement or distensibility of peritoneum or bowel . stretching pain secondary to adhesions attached to the liver , intestine , or other organs
may also contribute to chronic abdominal pain ; and the adhesions can partially or intermittently cause intestinal obstruction .
one study noted that small adhesions appear to cause recurrent pain without other symptoms , whereas large adhesions produce pain in combination with symptoms indicative of intermittent bowel obstruction .
enthusiasm for elective adhesiolysis is often limited by the concern about subsequent scar tissue formation following major laparotomy .
although the etiology for intraabdominal scar tissue formation is likely to be multifactorial , the inflammatory response , which is decreased in laparoscopy versus laparotomy , has been considered a cause for subsequent scar tissue formation .
therefore , it is possible that laparoscopic adhesiolysis would result in immediate resolution of symptoms attributed to intraabdominal adhesions , with less likelihood of subsequent recurrence of adhesions and symptoms .
our operative technique includes complete lysis of all adhesions that have resulted in fixation of the small and large intestine to the abdominal wall . except in those patients with operative findings of an obvious transition from dilated to decompressed bowel
, we do not routinely inspect the entire length of the small intestine , searching for interloop adhesions .
we believe excessive manipulation of the small intestine may increase the risk of enterotomies . so far , with a mean follow - up of 11 months , the only patient who has required repeat abdominal surgery for recurrent symptoms is 1 of the 3 patients who required major bowel resection at the time of her initial adhesiolysis , supporting the adequacy of our technique of adhesiolysis .
identification of other intraabdominal pathology through the extensive use of less - invasive preoperative testing should result in a low incidence of nontherapeutic adhesiolysis .
fifteen patients excluded from our study had other major abdominal procedures performed at the time of their adhesiolysis .
all of these patients were extensively evaluated preoperatively and found to have other possible sources for their chronic abdominal pain . during their operations , however , all 15 patients underwent similar extensive adhesiolysis to prevent a future operative procedure .
we believe that an extensive pre - operative workup should be used before attributing symptoms of chronic abdominal pain to intraabdominal scar tissue .
additionally , we believe that patients with unusual preoperative abdominal pain should undergo adhesiolysis at the time of their laparoscopy for other preoperatively detected intraabdominal pathology . as early as 1992 , several authors suggested that laparoscopy in the setting of bowel obstruction may yield inadequate enterolysis , and is likely to be dangerous .
more recently , other authors have demonstrated acceptable results with laparoscopic lysis of adhesions in the setting of acute intestinal obstruction . in our study , all 3 patients who underwent adhesiolysis after hospitalization for acute bowel obstruction sustained enterotomies .
one was repaired laparoscopically , but 2 required conversion to laparotomy for resection of devitalized bowel , and 1 of the 2 patients has since required another operative procedure for recurrent bowel obstruction .
in contrast , the 2 patients who underwent adhesiolysis for management of chronic bowel obstruction had no operative morbidities . based on this experience ,
we conclude that laparoscopic adhesiolysis performed for management of acute bowel obstruction may result in a high incidence of operative complication .
an overall 77.8% improvement in symptoms following laparoscopic adhesiolysis supports liberal use of diagnostic laparoscopy and lysis of adhesions in patients with chronic abdominal pain , bowel obstruction , or both , who have previously under - gone major abdominal surgery . to improve the yield of such an approach ,
in conclusion , laparoscopic adhesiolysis for chronic abdominal pain , recurrent bowel obstruction , or both , is safe and effective and results in minimal peri - operative morbidity . in the setting of acute bowel obstruction ,
 background : major abdominal operations result in random and unpredictable scar tissue formation . 
 intraabdominal scar tissue may contribute to recurrent episodes of bowel obstruction , chronic abdominal pain , or both . 
 laparoscopic adhesiolysis may provide relief of symptoms in patients with prior abdominal surgery with chronic abdominal pain or recurrent bowel 
 obstruction.methods:between september 1996 and april 1999 , 35 patients underwent laparoscopic adhesiolysis . 
 fifteen of the patients had adhesiolysis in conjunction with other major laparoscopic procedures and were excluded from the study . 
 twenty of the patients who underwent adhesiolysis only were retrospectively assessed for symptomatic relief as well as peri - operative morbidity and mortality.results:two of 20 patients were not available for long - term follow - up . in the 18 remaining patients , 
 laparoscopic adhesiolysis was performed on 13 patients with abdominal pain and 5 patients with recurrent bowel obstruction . 
 the follow - up period ranged from 1 to 32 ( mean 11 ) months . 
 sixteen of the 18 ( 88.9% ) operations were completed laparoscopically . 
 two operations were converted to open for partial enterectomy . 
 an additional enterotomy was repaired laparoscopically . 
 all 3 operative complications were encountered in patients operated on during hospitalization for active bowel obstruction . no mortalities or blood transfusions occurred . 
 one patient required rehospitalization for nonoperative management of an intraabdominal hematoma . 
 fourteen of the 18 ( 77.8% ) had subjective improvement in their quality of life after operation . 
 only 1 patient has required repeat adhesiolysis.conclusions:laparoscopic adhesiolysis is a safe and effective management option for patients with prior abdominal surgery with chronic abdominal pain or recurrent bowel obstruction not attributed to other intraabdominal pathology . 
 laparoscopic intervention in patients with active bowel obstruction may increase the risk of operative complications . 
INTRODUCTION
METHODS
RESULTS
DISCUSSION
CONCLUSION