Targeted laparoscopic abdominal adhesiolysis.

ABSTRACT

Postoperative abdominal pathogenic bands may produce intermittent subocclusive intestinal crises or chronic abdominal pain. Laparotomy has been widely used to define the diagnosis and perform adhesiolysis, but recurrences of the bands are frequent. Laparoscopy may reduce their incidence; nevertheless, 10-25% of cases recur with this procedure as well. Instead of using widespread adhesiolysis to treat this condition, a successful outcome may be achieved by removing only the pathogenic bands. It is thus essential to identify them. In order to do so, we performed a combined laparoscopic-endoscopic procedure. Following an abdominal focused radiological and endoscopic workup, two patients with intermittent abdominal pain from colonic subocclusion underwent laparoscopic adhesiolysis. This procedure was guided by intraoperative colonoscopy. During laparoscopic exploration of the abdominal cavity, intraoperative colonoscopy revealed the site of the obstacle whichcorresponded precisely to the position of the colonoscopic intraluminal. Thus, we identified the location of the transit obstacle and selected the bands to be removed. We then performed a targeted adhesiolysis. There were no postoperative complications. Symptom-free abdominal function was achieved in both cases 3 days after the operation. Both patients are symptom-free 1 year after treatment. Our preliminary experience indicates that this combined procedure, if properly performed (i.e., with a minimal amount of air inflation), is helpful in performing correct laparoscopic adhesiolysis.