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Long-term outcome, adhesions, and quality of life after laparoscopic and open surgical therapies for acute abdomen: follow-up of a prospective trial

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Abstract

Background

The objective of this study was to determine the long-term outcome of laparoscopic and open therapies for acute abdomen, and to assess the patients postoperative quality of life, with special attention to adhesions.

Methods

A follow-up study was conducted from June through December 2001 of a case-control trial of laparoscopic and open surgical treatment in patients with acute abdomen. Mean (median) duration of follow-up was 35.9 months (32.5) for the laparoscopic group (L) and 40.7 months (38.5) for the open group (O). A total of 284 (92%) of the original 310 study patients (108 L and 202 O) were contacted. Twenty-eight (9%) were confirmed to be dead. From the remaining 256 patients (131 men and 125 women, mean age [± SD] 38.9 ± 19.9 years), we enrolled 153(67 L and 91 O) in the follow-up. The main outcome measures were frequency of relapse requiring treatment, frequency of reoperations, incidence of adhesion ileus and incisional hernia, distant morbidity and mortality, satisfaction with therapy, and Gastrointestinal Quality of Life Index (GQLI) scores.

Results

The morbidity and mortality rates, readmission rates, incisional hernia rates, and scores for long-term quality of life were the same in both groups. The reoperation rate was significantly higher among L patients, but there were significantly fewer episodes of adhesion ileus in this group. Patient satisfaction was 85% in the L group and 73% in the O group (p = NS).

Conclusions

The laparoscopic treatment of patients with acute abdomen offers an outcome comparable to that achieved with the open approach. There were fewer episodes of adhesion ileus in laparoscopic patients. Consequently, the operative treatment of acute abdomen patients by laparoscopy can be recommended.

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References

  1. F Agresta J Michelet G Coluci N Bedin (2000) ArticleTitleEmergency laparoscopy: a community hospital experience Surg Endosc 14 484–487 Occurrence Handle10.1007/s004640000022 Occurrence Handle1:STN:280:DC%2BD3cvitlWgsA%3D%3D Occurrence Handle10858477

    Article  CAS  PubMed  Google Scholar 

  2. AA Al-Mulhim (2000) ArticleTitleLaparoscopic management of acute small bowel obstruction: experience from a Saudi teaching hospital Surg Endosc 14 157–160 Occurrence Handle10.1007/s004649900090 Occurrence Handle1:STN:280:DC%2BD3c7isVSqtA%3D%3D Occurrence Handle10656951

    Article  CAS  PubMed  Google Scholar 

  3. Ammori BJ, (2003) Laparoscopic surgery and reports on “long-term” follow-up. Surg Endosc 17: 662–663

    Article  CAS  PubMed  Google Scholar 

  4. N Black (1999) ArticleTitleEvidence based surgery: a passing fad? World J Surg 23 789–793 Occurrence Handle10.1007/s002689900581 Occurrence Handle1:STN:280:DyaK1Mzks1aktA%3D%3D Occurrence Handle10415204

    Article  CAS  PubMed  Google Scholar 

  5. MR Borgaonkar EJ Irvine (2000) ArticleTitleQuality of life measurement in gastrointestinal and liver disorders Gut 47 444–454 Occurrence Handle10.1136/gut.47.3.444 Occurrence Handle1:STN:280:DC%2BD3cvjs1Ghtg%3D%3D Occurrence Handle10940286

    Article  CAS  PubMed  Google Scholar 

  6. D Chosidow H Johanet T Montariol R Kielt C Manceau JP Marmuse G Benhamou (2000) ArticleTitleLaparoscopy for acute small-bowel obstruction secondary to adhesions J Laparoendosc Adv Surg Tech A 10 155–159 Occurrence Handle1:STN:280:DC%2BD3M%2FitVagsQ%3D%3D Occurrence Handle10883993

    CAS  PubMed  Google Scholar 

  7. RS Chung JJ Diaz V Chari (1998) ArticleTitleEfficacy of routine laparoscopy for the acute abdomen Surg Endosc 12 219–222 Occurrence Handle10.1007/s004649900638 Occurrence Handle1:STN:280:DyaK1c7mvFGluw%3D%3D Occurrence Handle9502699

    Article  CAS  PubMed  Google Scholar 

  8. RS Chung DY Rowland P Li J Diaz (1999) ArticleTitleA meta-analysis of randomized controlled trials of laparoscopic versus conventional appendectomy Am J Surg 177 250–256 Occurrence Handle10.1016/S0002-9610(99)00017-3 Occurrence Handle1:STN:280:DyaK1M3jsFaksw%3D%3D Occurrence Handle10219865

    Article  CAS  PubMed  Google Scholar 

  9. AJ Coburg T Carus U Kempf (1999) ArticleTitleLaparoscopy in intraabdominal infection: Its diagnostic value and therapeutic possibilities Zentralbl Chir 124 1137–1142 Occurrence Handle1:STN:280:DC%2BD3c7jsV2qug%3D%3D Occurrence Handle10670102

    CAS  PubMed  Google Scholar 

  10. A Coda M Bossottti F Ferri R Mattio G Ramellini A Poma F Quaglino et al. (1999) ArticleTitleIncisional hernia and fascial defect following laparoscopic surgery Surg Laparosc Endosc Percutan Tech 9 348–352 Occurrence Handle10.1097/00019509-199910000-00006 Occurrence Handle1:STN:280:DC%2BD3c3mtVGgsQ%3D%3D Occurrence Handle10803397

    Article  CAS  PubMed  Google Scholar 

  11. RL De Wilde ParticleDe (1991) ArticleTitleGoodbye to late bowel obstruction after appendicectomy Lancet 338 1012 Occurrence Handle10.1016/0140-6736(91)91871-Q Occurrence Handle1:STN:280:By2D3MnptFw%3D

    Article  CAS  Google Scholar 

  12. MP Diamond Operative Laparoscopy Study Group (1990) ArticleTitlePostoperative adhesion development after operative laparoscopy: evaluation at early second-look procedures Fertil Steril 55 700–704

    Google Scholar 

  13. H Ellis (1982) ArticleTitleThe causes and prevention of intestinal adhesions Br J Surg 69 241–243

    Google Scholar 

  14. H Ellis B Moran JN Thompson MC Parker MC Wilson D Menzies A McGuire et al. (1999) ArticleTitleAdhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study Lancet 353 1476–1480 Occurrence Handle10.1016/S0140-6736(98)09337-4 Occurrence Handle1:STN:280:DyaK1M3kslaksQ%3D%3D Occurrence Handle10232313

    Article  CAS  PubMed  Google Scholar 

  15. E Erdogan S Celayir E Eroglu E Yilmaz (2000) ArticleTitleThe relation between human leukocyte antigen (HLA) distribution and intestinal obstruction and adhesions in childhood (preliminary report) Pediatr Surg Int 16 374–376

    Google Scholar 

  16. E Eypasch JI Wiliams S Wood-Dauphinee BM Ure C Schmulling E Neugebauer H Troidl (1995) ArticleTitleGastrointestinal quality of life index, development, validation and application as a new instrument Br J Surg 82 216–222 Occurrence Handle7749697

    PubMed  Google Scholar 

  17. ME Franklin JP Dorman D Pharand (1994) ArticleTitleLaparoscopic surgery in small bowel obstruction Surg Laparosc Endosc 4 289–296 Occurrence Handle7952440

    PubMed  Google Scholar 

  18. JM Garbutt NJ Soper WD Shannon A Botero B Littenberg (1999) ArticleTitleMeta-analysis of randomized controlled trials comparing laparoscopic and open appendectomy Surg Laparosc Endosc 9 17–26 Occurrence Handle10.1097/00019509-199901000-00004 Occurrence Handle1:STN:280:DyaK1M7jtlKhsw%3D%3D Occurrence Handle9950122

    Article  CAS  PubMed  Google Scholar 

  19. CL Garrard RH Clements L Nanney JM Davidson WO Richards (1999) ArticleTitleAdhesion formation is reduced after laparoscopic surgery Surg Endosc 13 10–13 Occurrence Handle10.1007/s004649900887 Occurrence Handle1:STN:280:DyaK1M%2FovVaqsQ%3D%3D Occurrence Handle9869679

    Article  CAS  PubMed  Google Scholar 

  20. R Golub F Siddiqui D Pohl (1998) ArticleTitleLaparoscopic versus open appendectomy: a meta-analysis J Am Coll Surg 186 545–553 Occurrence Handle10.1016/S1072-7515(98)00080-5 Occurrence Handle1:STN:280:DyaK1c3ktlSmsQ%3D%3D Occurrence Handle9583695

    Article  CAS  PubMed  Google Scholar 

  21. AI Guzeev (2000) ArticleTitleWays of decreasing postoperative lethality in acute surgical diseases of the abdominal organs under conditions of a city hospital Vestn Khir Im J Grek 159 21–24 Occurrence Handle1:STN:280:DC%2BD3M%2FitlSqsg%3D%3D

    CAS  Google Scholar 

  22. C Henry C Smadja C Vons E Bobocescu D Mariette M Tahrat D Franco (1998) ArticleTitleResultats du traitement coelioscopique des urgences abdominales Ann Chir 52 223–228 Occurrence Handle1:STN:280:DyaK1cvisFSitA%3D%3D Occurrence Handle9752449

    CAS  PubMed  Google Scholar 

  23. AV Kapshitar (1998) ArticleTitleThe indications for performing diagnostic and therapeutic laparoscopy in emergency surgery on the abdominal organs Klin Khir 11 12–14 Occurrence Handle10077913

    PubMed  Google Scholar 

  24. C Khosrovani M Kohen B Guiberteau JC LeNeel (1994) ArticleTitlePerforations des ulceres duodenopyloriques. Facteurs prognostiques et choix therapeutiques. Etude retrospective de 140 malades Ann Chir (Paris) 48 345–349 Occurrence Handle1:STN:280:ByuA28fgt10%3D

    CAS  Google Scholar 

  25. L Kohler (1999) ArticleTitleEndoscopic surgery: what has passed the test? World J Surg 23 816–824 Occurrence Handle10.1007/s002689900585 Occurrence Handle10415208

    Article  PubMed  Google Scholar 

  26. M Łacki Z Jackiewicz J Zawadzki E Klimkiewicz-Wiesiołek (1980) ArticleTitleAnalysis of deaths after emergency abdominal operations Wiad Lek 15 1201–1206

    Google Scholar 

  27. WY Lau (1996) ArticleTitleA randomized study comparing laparoscopic vs open repair of peptic ulcer using suture and sutureless technique Ann Surg 224 131–138 Occurrence Handle10.1097/00000658-199608000-00004 Occurrence Handle1:STN:280:BymA3srgsV0%3D Occurrence Handle8757375

    Article  CAS  PubMed  Google Scholar 

  28. K Lawrence (1994) ArticleTitleMinimal access surgery: harnessing the revolution Lancet 343 308–309 Occurrence Handle10.1016/S0140-6736(94)91158-4 Occurrence Handle1:STN:280:ByuC38rnvVA%3D Occurrence Handle7905140

    Article  CAS  PubMed  Google Scholar 

  29. H Levard MJ Boudet S Msika JM Molkhou JM Hay Y Laborde M Gillet et al. (2001) ArticleTitleLaparoscopic treatment of acute small bowel obstruction: a multicentre retrospective study ANZ J Surg 71 641–646 Occurrence Handle10.1046/j.0004-8682.2001.02222.x Occurrence Handle1:STN:280:DC%2BD3MnovFOksg%3D%3D Occurrence Handle11736822

    Article  CAS  PubMed  Google Scholar 

  30. MM Lindner H Wacha U Feldman G Wesch RA Streifensand E Gundlach (1987) ArticleTitleDer Manheimer Peritonitis-Index Chirurg 58 84–92 Occurrence Handle3568820

    PubMed  Google Scholar 

  31. J Mais FW Eigler (1998) ArticleTitleKann “innere Darmschienung” das ileusrezidiv verhindern? Ergebnisse einer retrospektiven Vergleichsstudie Chirurg 69 168–173 Occurrence Handle10.1007/s001040050391 Occurrence Handle1:STN:280:DyaK1c3ht1Khtg%3D%3D Occurrence Handle9551260

    Article  CAS  PubMed  Google Scholar 

  32. Majewski, WD (2000) “ Laparoscopy for the acute abdomen and trauma” In: Mouiel, J, Montori, A (editors), Proceedings of the 8th International Congress of the European Association for Endoscopic Surgery, Monduzzi Editore, Bologna, pp 63–68

  33. RS McLeod (1999) ArticleTitleIssues in surgical randomized controlled trials World J Surg 23 1210–1214 Occurrence Handle10.1007/s002689900649 Occurrence Handle1:STN:280:DC%2BD3c%2FitVGgtA%3D%3D Occurrence Handle10552108

    Article  CAS  PubMed  Google Scholar 

  34. MA Memon RJ Fitzgibbons (1997) ArticleTitleThe role of minimal access surgery in the acute abdomen Surg Clin North Am 6 1333–1353

    Google Scholar 

  35. P Miettinen P Pasanen A Salonen J Lahtinen E Alhava (1966) ArticleTitleThe outcome of elderly patients after operations for acute abdomen Ann Chir Gynecol 85 11–15

    Google Scholar 

  36. A Mingoli A Puggioni G Sgarzini G Luciani F Corzani F Ciccarone E Baldassare et al. (1999) ArticleTitleIncidence of incisional hernia following emergency abdominal surgery Ital J Gastroenterol Hepatol 31 449–453 Occurrence Handle1:STN:280:DC%2BD3c%2Fkt1yitg%3D%3D Occurrence Handle10575560

    CAS  PubMed  Google Scholar 

  37. C Moebius HJ Stein M Feith H Feussner JR Siewert (2001) ArticleTitleQuality of life before and after laparoscopic Nissen fundoplication Surg Endosc 15 353–356 Occurrence Handle10.1007/s004640090045 Occurrence Handle11395814

    Article  PubMed  Google Scholar 

  38. B Navez JM Arimonnt P Guiot (1998) ArticleTitleLaparoscopic approach in acute small bowel obstruction: a preview of 68 patients Hepatogastroenterology 45 2146–2150

    Google Scholar 

  39. WD Otte K Schneiders (2000) ArticleTitleValue of laparoscopy in acute abdomen Zentralbl Chir 125 74–76 Occurrence Handle1:STN:280:DC%2BD3c7mslyitQ%3D%3D

    CAS  Google Scholar 

  40. R Sanz-Lopez C Martinez-Ramos JR Nunez-Pena M Ruiz Gopegui Particlede L Pastor-Sirera S Tamames-Escobar (1999) ArticleTitleIncisional hernias after laparoscopic vs open cholecystectomy Surg Endosc 13 922–924 Occurrence Handle10.1007/s004649901135 Occurrence Handle1:STN:280:DyaK1MzotVKltA%3D%3D Occurrence Handle10449854

    Article  CAS  PubMed  Google Scholar 

  41. Y Sato K Ido M Kumagai N Isoda M Hozumi N Nagamine K Ono et al. (2001) ArticleTitleLaparoscopic adhesiolysis for recurrent small bowel obstruction: long-term follow-up Gastrointest Endosc 54 476–479 Occurrence Handle10.1067/mge.2001.117760 Occurrence Handle1:STN:280:DC%2BD3MrjtValtA%3D%3D Occurrence Handle11577310

    Article  CAS  PubMed  Google Scholar 

  42. M Schäfer L. MW Krähenbühl Bücher (1998) ArticleTitleComparison of adhesion formation in open and laparoscopic surgery Dig Surg 15 148–152 Occurrence Handle10.1159/000018609 Occurrence Handle9845578

    Article  PubMed  Google Scholar 

  43. SJ Spechler E Lee D Ahnen RJ Goyal I Hirano F Ramirez JP Raufman et al. (2001) ArticleTitleLong-term outcome of medical and surgical therapies for gastroesophageal reflux disease JAMA 285 2331–2338 Occurrence Handle10.1001/jama.285.18.2331 Occurrence Handle1:CAS:528:DC%2BD3MXjvFCksbg%3D Occurrence Handle11343480

    Article  CAS  PubMed  Google Scholar 

  44. P Strickland DJ Lourie EA Suddleson JB Blitz SC Stain (1999) ArticleTitleIs laparoscopy safe and effective for treatment of acute small-bowel obstruction? Surg Endosc 13 695–698 Occurrence Handle10.1007/s004649901075 Occurrence Handle1:STN:280:DyaK1Mzhs1equw%3D%3D Occurrence Handle10384077

    Article  CAS  PubMed  Google Scholar 

  45. EN Tavmergen H Mecke K Semm (1990) ArticleTitleHaufigkeit intraabdominaler Adhaesionen nach Pelviskopie und Laparotomie Zentbl Gynakol 112 1163–1169 Occurrence Handle1:STN:280:By6C3M3itlw%3D

    CAS  Google Scholar 

  46. A Tittel KH Treutner S Titkova A Ottlinger V Schumpelick (2001) ArticleTitleNew adhesion formation after laparoscopic and conventional adhesiolysis Surg Endosc 15 44–46 Occurrence Handle10.1007/s004640000256 Occurrence Handle1:STN:280:DC%2BD3M7ptlSqtg%3D%3D Occurrence Handle11178761

    Article  CAS  PubMed  Google Scholar 

  47. WW Vrijland J Jeekel HJ Geldorp ParticleVan DJ Swank HJ Bonjer (2003) ArticleTitleAbdominal adhesions: intestinal obstruction, pain, and infertility Surg Endosc 17 1017–1022 Occurrence Handle10.1007/s00464-002-9208-9 Occurrence Handle1:STN:280:DC%2BD2czos1CgsQ%3D%3D Occurrence Handle12632122

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This paper is a part of W.D.M.’s habilitation thesis. The expert editorial help of Alicja Walczak, M.D.,Ph.D., head of the Epidemiology Department of Pomeranian Medical University, and Zbigniew Szych, M.D., biostatistician, is gratefully acknowledged.

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  1. Department of General and Transplantation Surgery and Faculty of Nursing, Pomeranian Medical University, 72 Powstańców Wlkp. Street, 70-111, Szczecin, Poland

    W. D. Majewski

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Correspondence to W. D. Majewski.

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Majewski, W.D. Long-term outcome, adhesions, and quality of life after laparoscopic and open surgical therapies for acute abdomen: follow-up of a prospective trial. Surg Endosc 19, 81–90 (2005). https://doi.org/10.1007/s00464-003-9333-0

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