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WJOLS
Comparative Study of Postoperative Adhesions by Laparotomy and Laparoscopic Procedures
ORIGINAL ARTICLE
Comparative Study of Postoperative Adhesions

by Laparotomy and Laparoscopic Procedures

Rama Hegde

Government Hospital, Sirsi, Karwar, Karnataka, India
Correspondence: Rama Hegde, Government Hospital, Sirsi, Karwar, Karnataka-581403, India, e-mail: ramahegde7@rediff mail.com

Abstract
Background: Abdominal operations result in random and unpredictable adhesion formation. Postoperative adhesion may contribute to
recurrent episodes of small bowel obstruction, chronic pain abdomen or both. Laparotomy and laparoscopy are the modes used to treat
the adhesion related complications.
Aims and objectives: (1) To study the adhesion related complications and treat the same by means of laparotomy and laparoscopic
procedures. (2) To study how the risk of postoperative adhesions can be minimized.
Materials and methods: About 50 cases from March 2007 to February 2009 were studied in Government hospital, Sirsi, Karnataka,
India. Patients who underwent some surgical procedures before presenting with adhesions related complications like small bowel
obstruction and chronic pain abdomen were considered. Patients who required intervention were treated with surgical procedures.
Patients who presented with obstructive features underwent laparotomy and who presented with chronic pain abdomen underwent
laparoscopy.
Results: All the 50 patients who were in our study had undergone some conventional surgeries in previous instance. No patient in our
study had undergone laparoscopy in previous instance. Appendicectomy (40%), lower segment cesarean section (22%) were the
common surgeries which resulted in adhesions. Thirty-four patients in our study presented with obstructive features, underwent
laparotomy and adhesiolysis. Sixteen patients in our study underwent laparoscopy for chronic pain abdomen. Both surgeries were safe
and resulted in recovery of almost all patients. We could not follow-up most of the patients after 3 months so the outcome of adhesiolysis
by both procedures is not known.
Conclusion: (1) Conventional surgeries leads to more adhesion formation than the minimal invasive procedures. (2) Appendicectomy
and pelvic surgeries are the common cause of adhesions. (3) Both laparotomy and laparoscopy can be safely used as mode of
treatment of adhesion related complications. (4) Operative treatment of acute abdomen by laparoscopy can be recommended.
Keywords: Laparotomy, laparoscopy, postoperative adhesions, adhesiolysis.

INTRODUCTION adhesion. Intra-abdominal adhesions may be prevented by
minimizing injury and there is increasing evidence that
Postoperative adhesions remain one of the most common
laparoscopic surgery is an important method of adhesion
problems which the surgeons have to face in present time.
prevention.
Adhesions are bands of tissues that connect anatomic sites
at locations, where there should not be connections. Post- OBJECTIVES
operative surgical adhesions are formed as a result of trauma,
I opted to take this study with following aims and objectives:
infection or injury to tissue. A surgical incision made into
1. To study adhesion related complications and to treat the
abdominal wall in an aseptic injury, yet it may get infected.
same by means of laparoscopy and laparotomy.
Over the past two decades there have been many claims
2. To study how the risk of postoperative adhesions can
made that alternative in mode of access into abdominal cavity
be minimized.
or instruments utilized will reduce postoperative adhesions. 3. To asses clinically the feasibility or limitations of laparos-
There is little evidence that development of adhesions in copy.
humans is less prevalent following laparoscopic procedures
compared to laparotomies. There is high incidence (40 to MATERIALS AND METHODS
60%) of morbid events like small bowel obstruction Postoperative adhesions presenting as acute and subacute
associated with presence of adhesions. Mortality has been intestinal obstruction is one of the common condition pre-
reported to be up to 30%. Adhesions result in large surgical senting in surgical department. In this study, I have taken
workload and cost to health care systems. Good surgical the patients who attended the OPD and emergency
technique remains an important part of prevention of department from March 2007 to February 2009.

World Journal of Laparoscopic Surgery, January-April 2010;3(1):31-36 31