Laparoscopic adhesiolysis for chronic abdominal pain: an objective assessment.

BACKGROUND AND PURPOSE: Postoperative adhesions frequently occur and can account for various symptoms, including chronic abdominal pain. Conventional adhesiolysis by laparotomy results in an unacceptably high rate of recurrence. A minimally invasive procedure (laparoscopic adhesiolysis) might improve the outcome by inflicting less surgical trauma, but well-documented reports focused on laparoscopic adhesiolysis for chronic abdominal pain are lacking. PATIENTS AND METHODS: Twelve consecutive patients with chronic abdominal pain caused by adhesions who were treated by laparoscopic adhesiolysis were assessed preoperatively and during a 1-year follow-up period applying validated scoring systems: McGill and SLC-90 tests to evaluate personalities and MOS SF-36 and GIQLI questionnaires for the quality of life assessments. RESULTS: No psychological influences were identified. Only two patients experienced a lasting improvement in quality of life, and five patients had more or less stable complaints. Five patients required laparotomy within a year after laparoscopic adhesiolysis. CONCLUSIONS: Laparoscopic adhesiolysis has yet not passed the stage of clinical trial and requires objective evaluation, including detailed information on recurrence and de novo adhesions in correlation with clinical outcome.

Mobility of the first tarsometatarsal joint in relation to hallux valgus deformity: anatomical and biomechanical aspects.

Hypermobility of the first tarsometatarsal (TMT 1) joint is suggested to be an important factor in the cause and progression of hallux valgus deformity. Hypermobility of the TMT 1 joint is tested clinically in the sagittal plane, but an important deformation also exists in the transversal plane: metatarsus primus varus. This in vitro study was undertaken to investigate the relation between the mobility of the TMT 1 joint in these two planes and to investigate the correlation of the mobility with morphological variables. A second aim was to study the possible stabilizing effect of the tibialis anterior muscle, flexor hallucis longus muscle, and peroneus longus muscle on the TMT 1 joint. Nine embalmed human specimens were tested under standardized conditions. A 30-N force was applied to the head of the first metatarsal (MT 1) to pull in either the dorsal or medial direction. To simulate muscle force, 21 N was applied to the three tendons: all seven possible combinations of muscle action were tested in each plane of motion. Angular displacements were measured using 2-dimensional LED video registration. TMT 1 mobility is a relevant factor in MT 1 mobility in the sagittal and transversal planes, the peroneus longus has a stabilizing effect on this joint, and the effect of the flexor hallucis longus on this joint is different in both planes. When considering a Lapidus procedure for surgically correcting a hallux valgus, the mobility of MT 1 in the transversal plane should also be assessed, but so far no objective clinical test in this plane has been described.

Long-term outcomes and quality of life after laparoscopic adhesiolysis for chronic abdominal pain.

STUDY OBJECTIVE: To evaluate clinical outcome in terms of pain and quality of life after laparoscopic adhesiolysis. DESIGN: Prospective observational study (Canadian Task Force II-3). SETTING: University-affiliated medical center. PATIENTS: Twenty-three patients (22 women). INTERVENTION: Laparoscopic adhesiolysis for chronic abdominal pain. MEASUREMENTS AND MAIN RESULTS: Pain was assessed by validated McGill score. Patients with an intraindividual decrease in pain score of 5 points or more were considered successes. Quality of life was assessed by the SF-36 and gastrointestinal quality of life index. Patients were evaluated before and at intervals until 2 years after adhesiolysis. The mean pain score before adhesiolysis was 30.5 (range: 17-40). At 2 years of follow-up, 10 (45%) of 22 patients (95% CI 0.244-0.678) were considered successes. They reported significant improvement in quality of life on scales physical, role physical, and social function, and fewer gastrointestinal symptoms. Twelve women (55%) had a complete relapse, and most were not motivated to visit the pain clinic after 6 months. CONCLUSION: Laparoscopic adhesiolysis for chronic abdominal pain was successful in only 45% of patients.