Page 33 - World Journal of Laparoscopic Surgery

Rama Hegde

Investigations which was resected and anastomosed. 1 case had gangrene
In the present study investigations did not have much role of whole of ascending colon up to transverse colon which
was resected and ileostomy was done. C Wellstein et al
to play. Plain X-ray abdomen was taken for all patients
reported 15 major intraoperative complication in lap group
presented with acute obstructive symptoms. Ultrasound was
off 52 patients and 8 intraoperative complications off 62
advised for patients preventing with chronic pain abdomen
to rule out other cause. Other investigations like CT, MRI conventional group (P = 0.156) results of present study is
comparable. No major postoperative complications were
were not affordable by patients. Routine investigations were
observed is our study except for prolonged paralytic ileus
done to all patients.
for few patients.
Treatment
Duration of Stay
In the present study, 34 patients (20-subacute and 14-acute
intestinal obstruction) were treated by laparotomy, In present study in laparoscopy and adhesiolysis, mean
suspecting adhesion to be the cause. Most of the cases duration of stay was 5.81 days and in laparotomy and

were opened with midline incisions; care was taken not to adhesiolysis it was 13.53 days. C Wellstein et al reported
injure the bowel. Adhesions in most conditions were to the 11.3 days of hospital stay for laparoscopy group and 18.1
anterior abdominal wall was released, wash was given with days for laparotomy group. This difference in laparoscopic
isotonic saline and in few patients ringer lactate solution group in our study might be due to choosing of small bowel
(300 ml) was left in the abdominal cavity. Peritoneum obstruction in the group. In present study only chronic pain
closure was avoided in many patients. In present study 16 abdomen cases were chosen. In present study in laparoscopy
patients presented with chronic pain abdomen for more than group, patient were mobilized on mean 2.94 days and
6 months. They were subjected to diagnostic laparoscopy. laparotomy group 6.97 days.
Pneumoperitoneum was created using veress needle in few
cases and open Hassan’s technique in others. Adhesiolysis FOLLOW-UP
was done and in few cases, 300 ml of Ringer lactate left
Most of the patients in our study did not turn up after 3
alone in abdominal cavity. No cases were converted to
months follow-up. So long-term outcome of procedure used
laparotomy. Parent S et al reported laparoscopic treatment
for adhesiolysis could not be made out.
of adhesion occlusion is a feasible operation. Sato Y et al
reported laparoscopic adhesiolysis is a safe and effective CONCLUSION
treatment for small bowel obstructions. Conversion to laparo-
tomy should be considered in patients well dense adhesions. 1. Postoperative adhesions are still a common surgical
However, in our study we subjected the patients to problem.
2. Mostly occurring in 20 to 40 years age group, the
laparotomy suspecting dense adhesions and possible high
complication rate. Swank DT et al reported laparoscopic active period of ones life.
adhesiolysis in patients with chronic pain abdomen seems 3. Pain abdomen vomiting and distension common
to be feasible and effective operation with considerable risk. symptoms.
4. Previous laparotomy is common cause of postoperative
Duration of Surgery adhesions than previous laparoscopy.
5. Second surgery requires more time than the normal
In present study, the mean time for laparoscopy and
and meticulous techniques to avoid complication.
adhesiolysis was 53.44 minutes and laparotomy and
6. Previous appendicectomy is the commonest cause of
adhesiolysis was 92.65 minutes.
postoperative adhesion in males. Previous pelvic
surgeries commonest among female.
Intraoperative Complications
7. Minimally invasive procedures like laparoscopy
In present study, we had 9 complications–8 in laparotomy minimize the adhesion formation.
and 1 in laparoscopy. 3 enterotomies which occurred while 8. Diagnostic laparoscopy can be used as a mode of
release of adhesions which was closed primarily. 4 cases treatment for patient with chronic pain abdomen.
had bleeding–1 in laparoscopy and 3 in laparotomy for which 9. Laparoscopic adhesiolysis takes less time, less hospital
hemostasis was achieved. 1 case had a patch of gangrene stay and early ambulation.

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