Results after laparoscopic lysis of adhesions and placement of seprafilm for intractable abdominal pain |
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Authors: | L Khaitan S Scholz HL Houston WO Richards |
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Institution: | (1) Department of Surgery, Vanderbilt University Medical Center, D5203 MCN, Nashville, TN 37232, USA, US |
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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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