Laparoscopic treatment of peritoneal adhesions

Based on experience of treatment of 3000 patients with peritoneal comissures, new methods of diagnosis, prevention and treatment of this disease were developed and used. Exact verification of location and degree of comissures permits carrying out minimally invasive surgical procedures. A new variant of membranous allo-abdominal graft with anti-infective and anti-adhesive properties was developed and used for prevention of comissures. This approach leads to reduction of the number of ...     

Laparoscopic treatment of postoperative peritoneal adhesions

75 patients with postoperative peritoneal adhesions, complicated by a severe pain syndrome, were operated on during 2003-2006 yy. The preoperative use of the enzyme medication in 28 patients allowed therefore the conduction of adequate laparoscopic adhesiolysis. There were no complications and recurrences registered at follow-up. The postoperative hospital stay averaged 3.7 days.     

Special techniques in pain management: lysis of adhesions

Low back pain, with or without radicular symptoms, is a common medical condition. It can cause mild to severe suffering, high health costs, and disability. Most sufferers recover quickly and are left without sequelae. The less fortunate group of patients who do not improve despite conservative and mildly interventional therapy, find themselves in search of a more effective treatment. To enhance treatment outcome, an understanding of the pathophysiology of the underlying pain and the design of target-specific treatment modalities is important.     

Laparoscopic kidney donation: The impact of adhesions

Background Adhesion formation following abdominal surgery causes substantial burden to society. Laparoscopic donor nephrectomy (LDN) offers an opportunity to study the prevalence of adhesions in healthy individuals. Furthermore we evaluated whether or not adhesions hindered LDN. Methods Data of 161 LDNs were prospectively collected. The presence of adhesions was documented. Parameters influenced by the presence of adhesions such as operation time, blood loss, and intraoperative complications were documented. Results Twenty-eight of 44 donors (64%) who had had prior abdominal surgery presented with adhesions at laparoscopy versus 61 of 107 donors (52%) who had no history of abdominal surgery (P = 0.22). Conversion and complication rate, operation times, and blood loss did not differ between those with and without a previous history of abdominal surgery. Blood loss and operation time did not differ between donors with and without adhesions. The number of conversions to open was significantly higher in donors with adhesions (9 versus 0, P = 0.005). Three conversions were due to adhesions. Conclusion Adhesions are present in a significant number of healthy individuals regardless of a history of previous abdominal operations. As these operations are of no predictive value for the number and complexity of adhesion formation, we advocate starting live kidney donation laparoscopically as the procedure can be most probably conducted successfully by this approach. None of the above mentioned authors have any conflict of interest. Niels Kok is partially funded by an unrestricted grant of the Dutch Kidney Foundation.     

Laparoscopic treatment of small bowel obstruction arising on adhesions

OBJECTIVES: Determine the feasibility of laparoscopy, with the objective as well as the subjective benefits offered to patients, and the possible contra-indications of this type of surgery in the treatment of mechanical intestinal ileus. PATIENTS AND MATERIAL: This concerned 20 patients who came to the hospital with a picture of intestinal obstruction. All had a history of at least one abdominal operation. The diagnosis of mechanical occlusion due to band adhesions was presumed on the basis of the clinical and complementary examinations, particularly x-rays, and confirmed in the course of the operation. All patients were operated by laparoscopy after failure of non-invasive treatment. RESULTS: Results obtained are encouraging since 60% of the patients were successfully treated by laparoscopy alone. The patients' comfort and length of hospital stay are improved by laparoscopy. There is no relation between previous surgical history and the results of the technique. CONCLUSIONS: Most failures were due to the time interval between onset of symptoms and the operation. Early operation therefore seems to increase the chances of success.     

Laparoscopic management of obstructive hepatoduodenal adhesions after open antireflux procedure

The case of a 3-year-old child who underwent open antireflux surgery for severe gastroesophageal reflux is presented. One month after the procedure, the child presented with abstinence from feeds, and vomiting after food intake. Esophagogastroscopy ruled out pathology in the area around the wrap. Upper gastrointestinal contrast studies demonstrated a kinking of the duodenal loop. Laparoscopy revealed severe adhesions between the duodenum and liver with kinking of the duodenum. The adhesions were taken down with careful dissection using hooked laparoscopic scissors. The symptoms subsided immediately after surgery and the further course and follow-up examinations were uneventful. The complication of mechanical ileus due to hepatoduodenal adhesions with severe kinking of the duodenum after antireflux surgery and with successful laparoscopic management has never been reported to date.     

Results after laparoscopic lysis of adhesions and placement of seprafilm for intractable abdominal pain

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.     

Laparoscopic evaluation of abdominal adhesions with different prosthetic meshes in rabbits.

BACKGROUND: The use of prosthetic materials to reinforce the abdominal wall is associated with a low index of recurrence; however, intraperitoneal placement of a foreign body may lead to adhesions. The present investigation was designed to determine adhesion formation with commercially available meshes implanted laparoscopically in rabbits. METHODS: Three different meshes were implanted laparoscopically in 24 rabbits: polypropylene (mesh A), polypropylene and sodium hyaluronate-carboxymethylcellulose (mesh B), and polypropylene and expanded polytetrafluoroethylene (mesh C). Sites of implantation for each mesh (the left lower quadrant, right lower quadrant, and lower midline) were randomly determined so that every rabbit had all 3 meshes implanted. All animals underwent diagnostic laparoscopy after 28 days to grade adhesions and histological analysis of inflammation. RESULTS: Adhesions were noticed in 46 of the 72 meshes implanted (64%). The number of adhesions was higher for mesh C (87.5%) compared with meshes A (62.5%) and B (41.6%). The severity of adhesions was also higher for mesh C (grade I in 14, II in 6, and III in 1) compared with mesh A (grade I in 10, II in 4, and III in 1 case) and B (all of them grade II). Histological inflammatory reaction was classified as mild in 23 cases of mesh A, 15 of mesh B, and 23 of mesh C. A moderate reaction was found in 1 case of mesh A, 4 cases of mesh B, and 1 case of mesh C. Severe reaction was induced in 5 cases of mesh B. Mesh B induced a higher inflammatory reaction compared with the other meshes. CONCLUSIONS: All meshes induced adhesions of different grades. Mesh B had fewer adhesions and more intense inflammation them did the others.     

Nationwide impact of laparoscopic lysis of adhesions in the management of intestinal obstruction in the US

BACKGROUND: Treatment of adhesion-related complications is cost intensive and presents a considerable burden to the health care system. The objective of this study was to compare open (OLA) and laparoscopic lysis of adhesions (LLA) in the treatment of intestinal obstruction, based on a nationwide representative sample. STUDY DESIGN: Patients with intestinal obstruction undergoing OLA, LLA, and conversion were identified from the 2002 National Inpatient Sample. After propensity methods were used to adjust for covariates including patient demographics, hospital characteristics, and comorbidities, the impact of OLA and LLA was analyzed concerning in-hospital mortality, postoperative complications, length of stay (LOS), and in-hospital costs. RESULTS: Of 6,165 patients, 88.6% underwent OLA and 11.4% had LLA. Conversion was required in 17.2% of LLA patients. Unadjusted mortality was equal between LLA and conversion (1.7%) and half the rate compared with OLA (3.4%) (p = 0.014). After adjusting with propensity methods, the odds of complications in the LLA group (intention to treat) were 25% less than in the OLA (p = 0.008). The LLA group had a 27% shorter LOS (p = 0.0001) and was 9% less expensive than the OLA group (p = 0.0003). There was no statistical significant difference for LOS, complications, and costs between the conversion and OLA groups. CONCLUSIONS: Results from this study suggest that when LLA is applied to selected patients with intestinal obstruction, there are reductions in postoperative complications, LOS, and costs. Prospective studies are needed to confirm these data and better identify the subgroup of patients who have improved outcomes with LLA.     

腹腔镜治疗小儿肠粘连26例报告

目的:探讨腹腔镜治疗小儿术后粘连性肠梗阻的可行性和适应证。方法:回顾分析1994年至2004年8月因粘连性肠梗阻行腹腔镜下肠粘连松解术26例的临床资料。结果:24例手术成功,2例中转开腹,无术后并发症,随访未见复发。结论:腹腔镜肠粘连松解术切口小、腹膜创面小,腹腔干扰少,能较大限度地减少术后腹腔内再粘连,为粘连性肠梗阻的外科治疗提供了一种新方法,不仅在成人,在小儿肠粘连中也可应用。     

Optochiasmatic arachnoiditis with treatment by surgical lysis of adhesions, corticosteroids, and cyclophosphamide: report of a case

A 24-year-old woman presented with progressive optochiasmatic arachnoiditis causing progressively worsening visual loss associated with headache and amenorrhea. Treatment with the standard initial therapy of dexamethasone, warfarin, and dipyridamole was unsuccessful at halting her disease process. Surgical lysis of adhesions led to a temporary improvement and then deterioration. A course of therapy with cyclophosphamide was initiated and her response to this therapy resulted in resolution of her headaches, return of her vision to normal, and resumption of her normal menstrual cycles.     

Laparoscopic observations of adhesions between peritoneal dialysis catheters and intraperitoneal organs: A retrospective,observational study

Laparoscopy provides extensive data for the decannulation of a peritoneal dialysis catheter and is being increasingly used to diagnose encapsulating peritoneal sclerosis. However, there are few reports on the methods of decannulation of peritoneal dialysis catheters. In this study, we examined the laparoscopic findings and postoperative complications of patients undergoing peritoneal dialysis catheter removal. A total of 119 laparoscopic decannulations of peritoneal dialysis catheters were performed between 2003 and 2018 at the Juntendo University Hospital and Juntendo University Nerima Hospital. Laparoscopy was performed during peritoneal dialysis catheter removal by a gastrointestinal surgeon. Patient characteristics such as age, sex, duration of peritoneal dialysis, history of peritonitis and age at the time of peritoneal dialysis termination were assessed. Of these 119 cases, 19 (16.0%) showed adhesion between the peritoneal dialysis catheter and intraperitoneal organs. There were 13 (10.9%) cases involving a tangled omentum, 4 (3.4%) cases involving the small intestine and 2 (1.7%) cases of adhesions extending from the bowels to the abdominal wall. No postoperative complications were associated with the laparoscopic surgery. In these cases, blind decannulation of the peritoneal dialysis catheter may result in injury to the gastrointestinal tract in patients with adhesions. Therefore, we need to pay attention to adhesions between peritoneal dialysis catheters and intraperitoneal organs, and laparoscopy could be a valuable tool in detecting such adhesions and ensuring patient safety.