Adhesions are bands of scar tissue that form between organs. In the abdomen, they form after an abdominal surgery or after a bout of intra-abdominal infection (ie, pelvic inflammatory disease, diverticulitis). More than 95% of patients who undergo abdominal surgery develop adhesions; these are almost inevitably part of the body’s healing process.
Although most adhesions are asymptomatic, some can cause bowel obstructions, infertility, and chronic pain. In a study that reviewed over 18,912 patients who underwent previous open abdominal surgery, 14.3% presented with a bowel obstruction in 2 years, with 2.6% of these patients requiring adhesiolysis to relieve the bowel obstruction. Postoperative adhesions account for 74% of cases of small-bowel obstruction. Kista endometriosis is one of the most common etiologies because peritoneal lesions activate a chronic extensive inflammatory process, leading to dense adhesions. In fact, kista endometriosis-related adhesions are so common that the American Society for Reproductive Medicine (ASRM) assigns more points to adhesions for the staging of kista endometriosis than it does to the disease itself.
Laparotomy with open adhesiolysis has been the treatment of choice for acute complete bowel obstructions. Patients who have partial obstructions, with soame enteric contents traversing the obstruction, may also require surgery if nonoperative measures fail. However, operation often leads to formation of new intra-abdominal adhesions in 10-30% of patients, which may necessitate another laparotomy for recurrent bowel obstruction in the future.
Laparoscopic adhesiolysis was successfully used by Dr Vijayavel for the treatment of severe bowel obstruction in one patient with a multiple adhesive band. The patient experience painful periods and painful sex as the bowels were stuck to the uterus. Dr Vijayavel released the bowels from the uterus successfully using laparascopic adhesiolysis technique.
Compared with the open approach to adhesiolysis, the laparoscopic approach offers the following:
- Less postoperative pain
- Decreased incidence of ventral hernia
- Reduced recovery time with earlier return of bowel function
- Shorter hospital stay