Page 32 - World Journal of Laparoscopic Surgery

Comparative Study of Postoperative Adhesions by Laparotomy and Laparoscopic Procedures

Diagnosis and Sex vs Procedure Correlation; Previous Surgeries
Age vs Clinical Presentation; Sex vs Diagnosis
In the present study, all the 50 patients underwent
Laparoscopy and adhesiolysis was done in 16 cases who laparotomy for some cause. No cases were available for
presented with pain abdomen, of which 11 were female study that underwent laparoscopy in first instance. This
and 5 male. Laparotomy and adhesiolysis was done in 34 shows that there is a reduction of adhesion formation after
cases that presented with acute and subacute intestinal laparoscopic surgery compared to open surgery.
obstruction of which 20 male and 14 female cases. Gutt CN et al reported that in all clinical studies most of
the experimental studies found a reduction of adhesion
Intraoperative Complications formation after laparoscopic surgery compared to open
surgery. Schafer M et al reported that laparoscopic surgical
Intraoperative complications—1 case in laparoscopy had
procedures with their minimal access to abdominal cavity
the intraoperative complication of bleeding. 7 cases had intra-
are associated with fewer postoperative adhesions compared
operative complication in laparotomy—3 enterotomy, 2
to open surgery, although adhesion formation cannot be
bleeding, 1 resection and anostomosis and 1 resection with
entirely prevented. Levrant SG et al reported prior
ileostomy. 41 cases (82%) did not have any intraoperative
laparotomy, whether through a midline vertical or
complications. suprapubic transverse incision, significantly increased the
frequency of anterior abdominal wall adhesion and thus
DISCUSSION adhesions may complicate the placement of the laparoscopic

Postoperative adhesions are one of the common surgical cannula through the umbilicus. Majewsji WD reported
laparoscopic treatment of patients with acute abdomen
problems all over the world. There is a little evidence that
offers an outcome comparable to that achieved with open
development of adhesions in humans less prevalent following
laparoscopic procedures versus open (laparotomy) approach. There were fewer episodes of adhesions ileus in
laparoscopic patients. Consequently the operative treatment
procedures. Major clinical concerns associated with post-
of acute abdomen patients by laparoscopy can be
operative adhesion formation are small bowel obstruction,
recommended. In the present study, appendicectomy and
chronic abdominal and pelvic pain, infertility. Open and
cholecystectomy were the leading previous surgeries which
laparoscopic adhesiolysis is done to treat the patient
led to adhesion formation in males. Cesarian, appendi-
presenting with adhesion related complications. This study
cectomy, hysterectomy were the leading previous surgeries
highlights the magnitude of problem of adhesion and
in females. Menzies D, Ellis H31 reported cholecystectomy,
treatment of the same by laparoscopic and laparotomy.
appendicectomy, colon surgery and pelvic surgery are
About 50 patients were treated from March 2007 to
associated more with adhesion formation. This study
Februrary 2009.
coincides with present study. In present study, all 50 patients
presented with pain abdomen. Distension of abdomen was
Age Incidence
present in 20 males and absent in 5 whereas
The youngest patient in the study was of 5 years and oldest
13 females presented with distention and absent in 12.
patient was 85 years old. The mean age was 40.10 years of Vomiting was present in 10 patients, 7 males and 3 females.
this 42.92 years for male and 37.32 years for female. The
mean difference in the age between male and female is not Clinical Presentation
statistically significant. In this study, 54% of patient belonged
In present study, 34 patients presented with obstructive
to 21 to 40 years of age.
symptoms. 14 acute and 20 subacute intestinal obstructions.
Previous studies by Majewski WD reported the mean
16 patients presented with chronic pain abdomen which
age of 38.9 ± 19.9 years. was off more than 6 month duration. Menzies D et al 31

Parent S et al reported in his study the mean age of 48.2 reported small bowel obstruction, chronic abdominal and
years. These studies almost correlate with present study. pelvic pain, infertility are of major clinical concern associated
with adhesion. Schafer M et al reported early and late bowel
Sex Incidence
obstruction, chronic abdominal pain and infertility all the
In the present study, there were 25 males and 25 females main clinical complications and they also increase the
among 50 cases. The male female ratio is 1:1. socioeconomic costs.
World Journal of Laparoscopic Surgery, January-April 2010;3(1):31-36 33