Adhesions are bands of scar tissue that form between organs. In the abdomen, they form after an abdominal surgery or after a bout of intra-abdominal infection (ie, pelvic inflammatory disease, diverticulitis). More than 95% of patients who undergo abdominal surgery develop adhesions; these are almost inevitably part of the body’s healing process.Although most adhesions are asymptomatic, some can cause bowel obstructions, infertility, and chronic pain. In a study that reviewed over 18,912 patients who underwent previous open abdominal surgery, 14.3% presented with a bowel obstruction in 2 years, with 2.6% of these patients requiring adhesiolysis to relieve the bowel obstruction.Postoperative adhesions account for 74% of cases of small-bowel obstruction. Laparotomy with open adhesiolysis has been the treatment of choice for acute complete bowel obstructions. Patients who have partial obstructions, with some enteric contents traversing the obstruction, may also require surgery if nonoperative measures fail. However, operation often leads to formation of new intra-abdominal adhesions in 10-30% of patients, which may necessitate another laparotomy for recurrent bowel obstruction in the future. Laparoscopic adhesiolysis was first described by a gynecologist for the treatment of chronic pelvic pain and infertility. In the early days of laparoscopy, previous abdominal surgery was a relative contraindication to performing most laparoscopic procedures. Laparoscopic surgery to relieve bowel obstructions was not routinely performed. However, in 1991, Bastug et al reported the successful use of laparoscopic adhesiolysis for small-bowel obstruction in one patient with a single adhesive band. Since then, many case series have documented this technique.Advanced technology with high-definition imaging, smaller cameras, and better instrumentation have allowed for an increasing number of adhesiolysis to be performed laparoscopically with good outcomes.
Compared with the open approach to adhesiolysis, the laparoscopic approach offers the following:
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