Skip to main content
SpringerLink
Log in

Laparoscopic Lysis of Adhesions

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Intra-abdominal adhesions constitute between 49% and 74% of the causes of small bowel obstruction. Traditionally, laparotomy and open adhesiolysis have been the treatment for patients who have failed conservative measures or when clinical and physiologic derangements suggest toxemia and/or ischemia. With the increased popularity of laparoscopy, recent promising reports indicate the feasibility and potential superiority of the minimally invasive approach to the adhesion-encased abdomen.

Methods

The purpose of this study was to assess the outcome of laparoscopic adhesiolysis and to provide technical tips that help in the success of this technique.

Results

The most important predictive factor of adhesion formation is a history of previous abdominal surgery ranging from 67%–93% in the literature. Conversely, 31% of scars from previous surgery have been free of adhesions, whereas up to 10% of patients without any prior surgical scars will have spontaneous adhesions of the bowel or omentum. Most intestinal obstructions follow open lower abdominopelvic surgeries such as colectomy, appendectomy, and hysterectomy. The most common complications associated with adhesions are small bowel obstruction (SBO) and chronic pain syndrome. The treatment of uncomplicated SBO is generally conservative, especially with incomplete obstruction and the absence of systemic toxemia, ischemia, or strangulation. When conservative treatment fails, surgical options include conventional open or minimally invasive approaches; the latter have become increasing more popular for lysis of adhesions and the treatment of SBO. Generally, 63% of the length of a laparotomy incision is involved in adhesion formation to the abdominal wall. Furthermore, the incidence of ventral hernia after a laparotomy ranges between 11% and 20% versus the 0.02%–2.4% incidence of port site herniation. Additional benefits of the minimally invasive approaches include a decreased incidence of wound infection and postoperative pneumonia and a more rapid return of bowel function resulting in a shorter hospital stay. In long-term follow up, the success rate of laparoscopic lysis of adhesions remains between 46% and 87%. Operative times for laparoscopy range from 58 to 108 minutes; conversion rates range from 6.7% to 43%; and the incidence of intraoperative enterotomy ranges from 3% to 17.6%. The length of hospitalization is 4–6 days in most series.

Conclusions

Laparoscopic lysis of adhesions seems to be safe in the hands of well-trained laparoscopic surgeons. This technique should be mastered by the advanced laparoscopic surgeon not only for its usefulness in the pathologies discussed here but also for adhesions commonly encountered during other laparoscopic procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Menzies D, Ellis H. Intestinal obstruction from adhesions—how big is the problem? Ann R Coll Surg Engl 1990;72:60–63

    PubMed  CAS  Google Scholar 

  2. Pickleman J. Small bowel obstruction. In Zinner MJ, editor, Maingot’s Abdominal Operations, London, Prentice-Hall, 1997;1159–1172

    Google Scholar 

  3. Welch P. Adhesions. In Welch JP, editor, Bowel Obstruction, Philadelphia, Saunders, 1990;154–165

    Google Scholar 

  4. Harris EA. Reoperation on the abdomen encased in adhesions. Am J Surg 2002;184:499–504; discussion 504

    PubMed  Google Scholar 

  5. Kahi CJ. Bowel obstruction and pseudo-obstruction. Gastroenterol Clin North Am 2003;32:1229–1247

    Article  PubMed  Google Scholar 

  6. Bizer LS. Small bowel obstruction: the role of nonoperative treatment in simple intestinal obstruction and predictive criteria for strangulation obstruction. Surgery 1981;89:407–413

    PubMed  CAS  Google Scholar 

  7. Beck DE, Opelka FG, Baily HR, et al. Incidence of small bowel obstruction and adhesiolysis after open colorectal and general surgery. Dis Colon Rectum 1999;42:241–248

    PubMed  CAS  Google Scholar 

  8. Weibel MA, Majno G. Peritoneal adhesions and their relation to abdominal surgery. Am J Surg 1973;126:345–353

    PubMed  CAS  Google Scholar 

  9. Luijendijk RW, Hop WCJ, van den Tol MP, et al. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 2000;343:392–398

    Article  PubMed  CAS  Google Scholar 

  10. Ellis H, Moran BJ, Thompson JN, et al. Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet 1999;353:1456–1457

    Google Scholar 

  11. Duepree HJ. Does means of access affect the incidence of small bowel obstruction and ventral hernia after bowel resection? Laparoscopy versus laparotomy. J Am Coll Surg 2003;197:177–181

    Article  PubMed  Google Scholar 

  12. Chopra R. Laparoscopic lysis of adhesions. Am Surg 2003;69:966–968

    PubMed  Google Scholar 

  13. Akman PC. A study of five hundred incisional hernias. J Int Coll Surg 1962;37:125–142

    PubMed  CAS  Google Scholar 

  14. Sato Y. Laparoscopic adhesiolysis for recurrent small bowel obstruction: long-term follow-up. Gastrointest Endosc 2001;54:476–479

    Article  PubMed  CAS  Google Scholar 

  15. Gutt CN, Oniu T, Schemmer P, et al. Fewer adhesions induced by laparoscopic surgery? Surg Endosc 2004;18:898–906

    Article  PubMed  CAS  Google Scholar 

  16. Di Lorenzo N. [Impact of laparoscopic surgery in the treatment of chronic abdominal pain syndrome] Chir Ital 2002;54:367–378

    PubMed  Google Scholar 

  17. Stringel G. Laparoscopy in the management of children with chronic recurrent abdominal pain. J Soc Laparoendosc Surg 1999; 3:215–219

    CAS  Google Scholar 

  18. Herrick SE. Human peritoneal adhesions are highly cellular, innervated, and vascularized. J Pathol 2000;192:67–72

    Article  PubMed  CAS  Google Scholar 

  19. Khaitan L. Results after laparoscopic lysis of adhesions and placement of Seprafilm for intractable abdominal pain. Surg Endosc 2003;17:247–253

    PubMed  CAS  Google Scholar 

  20. Swank DJ, Van Erp WF, Repelaer Van Driel OJ, et al. A prospective analysis of predictive factors on the results of laparoscopic adhesiolysis in patients with chronic abdominal pain. Surg Laparosc Endosc Percutan Tech 2003;13:88–94

    Article  PubMed  Google Scholar 

  21. Salky BA, Laparoscopic enteroclysis. In Phillips EH, Rosenthal RJ, editors, Operative Strategies in Laparoscopic Surgery. Springer-Verlag, Berlin 1995;207–210

    Google Scholar 

  22. Swank DJ, Swank-Bordewijk SC, Hop WC, et al. Laparoscopic adhesiolysis in patients with chronic abdominal pain: a blinded randomized controlled multicenter trial. Lancet 2003;361:1247–1251

    Article  PubMed  CAS  Google Scholar 

  23. Bastug DF, Trammell SW, Boland JP, et al. Laparoscopic adhesiolysis for small bowel obstruction. Surg Laparosc Endosc Percutan Tech 1991;1:259–262

    CAS  Google Scholar 

  24. Franklin ME Jr, Dorman JP, Pharand D. Laparoscopic surgery in acute small bowel obstruction. Surg Laparose Endosc 1994;4:289–296

    Google Scholar 

  25. Frager DH, Baer JW. Role of CT in evaluating patients with small bowel obstruction. Semin Ultrasound CT MRI 1995;16:127–140

    Article  CAS  Google Scholar 

  26. Sarr MG, Bulkley GB, Zuidema GD. Preoperative recognition of intestinal strangulation: prospective evaluation of diagnostic capability. Am J Surg 1983;145:176–182

    Article  PubMed  CAS  Google Scholar 

  27. Bryk D. Functional evaluation of small bowel obstruction by successive abdominal roentgenograms. AJR Am J Roentgenol 1972;116:262–275

    CAS  Google Scholar 

  28. Maglinte DDT. Peterson LA, Uahey TN, et al. Enteroclysis in partial small bowel obstruction. Am J Surg 1984;147:325–329

    PubMed  CAS  Google Scholar 

  29. Balthazar EJ, Birnbaum BA, Megibow AJ, et al. Closed loop and strangulating intestinal obstruction: CT signs. Radiology 1992;185:769–775

    PubMed  CAS  Google Scholar 

  30. Frager D. Intestinal obstruction role of CT. Gastroenterol Clin North Am 2002;31:777–799

    Article  PubMed  Google Scholar 

  31. Ibrahim IM, Wolodiger F, Sussman B, et al. Laparoscopic management of acute small-bowel obstruction. Surg Endosc 1996;10:1012–1015

    Article  PubMed  CAS  Google Scholar 

  32. Navez B, Arimont JM, Gujiot P. Laparoscopic approach in acute small bowel obstruction. A review of 68 patients. Hepatogastroenterology 1998;45:2146–2150

    PubMed  CAS  Google Scholar 

  33. Peritoneal adhesiolysis. In National Inpatient Profile 1993. Baltimore: HCIA Inc, 1994;653–655

  34. Ray NF, Larsen Jr JW, Stillman RJ, et al. Economic impact of hospitalizations for lower abdominal adhesiolysis in the United States in 1988. Surg Gynecol Obstet 1993;176:271–276

    PubMed  CAS  Google Scholar 

  35. Halpern NB. The difficult laparoscopy. Surg Clin North Am 1996;76:603–613

    Article  PubMed  CAS  Google Scholar 

  36. Nieuwenhuijzen M, Reijnen MM, Kuijpers JH, et al. Small bowel obstruction after total or subtotal colectomy: a 10-year retrospective review. Br J Surg 1998;85:1242–1245

    Article  PubMed  CAS  Google Scholar 

  37. Zbar RI, Crede WB, McKhann CF, et al. The postoperative incidence of small bowel obstruction following standard, open appendectomy and cholecystectomy: a six-year retrospective cohort study at Yale-New Haven Hospital. Conn Med 1993;57:123–127

    PubMed  CAS  Google Scholar 

  38. Becker JM, Dayton MT, Fazio VW, et al. Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membranea prospective, randomized, double-blind multicenter study. J Am Coll Surg 1996;183:297–306

    PubMed  CAS  Google Scholar 

  39. Akman PC. A study of five hundred incisional hernias. J Int Coll Surg 1962;37:125–142

    PubMed  CAS  Google Scholar 

  40. Montz FJ, Holschneider CH, Munro MG. Incisional hernias following laparoscopy: a survey of the American Association of Gynecologic Laparoscopists. Obstet Gynecol 1994;84:881–884

    PubMed  CAS  Google Scholar 

  41. Pekmezci S, Altinli E, Saribeyoglu K, et al. Enteroclysis-guided laparoscopic adhesiolysis in recurrent adhesive small bowel obstruction. Surg Laparosc Endosc Percutan Tech 2001;12:165–170

    Google Scholar 

  42. Levard H, Boudet M, Msika S, et al. Laparoscopic treatment of acute small bowel obstruction: a multicentre retrospective study. Aust N Z J Surg 2001;71:641–646

    Article  CAS  Google Scholar 

  43. Suter M, Zermatten P, Hakie N, et al. Laparoscopic management of mechanical small bowel obstruction: are there predictors of success of failure? Surg Endosc 2000;14:478–484

    PubMed  CAS  Google Scholar 

  44. Al-Mulhim AA. Laparoscopic management of acute small bowel obstruction: experience from a Saudi teaching hospital. Surg Endosc 2000;14:157–160

    Article  PubMed  CAS  Google Scholar 

  45. Chosidow D, Johanet H, Montario T, et al. Laparoscopy for acute small-bowel obstruction secondary to adhesions. J Laparoendosc Adv Surg Tech 2000;10:155–159

    CAS  Google Scholar 

  46. Strickland P, Lourie DJ, Suddleson EA, et al. Is laparoscopy safe and effective for treatment of acute small-bowel obstruction? Surg Endosc 1999;13:695–698

    Article  PubMed  CAS  Google Scholar 

  47. Leon EL, Metzger A, Tsiotos GG, et al. Laparoscopic management of small bowel obstruction: indications and outcomes. J Gastrointest Surg 1998;2:132–140

    PubMed  CAS  Google Scholar 

  48. Bailey IS, Rhodes M, O’Rourke N, et al. Laparoscopic management of acute small bowel obstruction. Br J Surg 1998;85:84–87

    Article  PubMed  CAS  Google Scholar 

  49. Nagle A, Ujiki M, Denham W, et al. Laparoscopic adhesiolysis for small bowel obstructions. Am J Surg 2004;187:464–470

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Bariatric Institute, Section of Minimally Invasive Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, Florida, 33331, USA

    Samuel Szomstein MD, Emanuele Lo Menzo MD, PhD, Conrad Simpfendorfer MD, Nathan Zundel MD & Raul J. Rosenthal MD

Authors
  1. Samuel Szomstein MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emanuele Lo Menzo MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Conrad Simpfendorfer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nathan Zundel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Raul J. Rosenthal MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Samuel Szomstein MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Szomstein, S., Menzo, E.L., Simpfendorfer, C. et al. Laparoscopic Lysis of Adhesions. World J. Surg. 30, 535–540 (2006). https://doi.org/10.1007/s00268-005-7778-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-005-7778-0

Keywords

Search

Navigation