-- ============================================================================ =========This month's topic: LAPAROSCOPIC LYSIS OF ADHESIONS
Parent S, Bresler L, Marchal F, Boissel P Celioscopic treatment of acute obstructions caused by adhesions of the small intestine. Experience of 35 cases Service de Chirurgie C, CHU de Nancy, Vandoeuvre-les-Nancy.J Chir (Paris) 1995 Oct;132(10):382
SUMMARY:Postoperative adhesions are the primary cause of occlusion of the small bowel. We evaluated the feasibility and the immediate postoperative resultsof laparoscopic procedures for acute adhesions on the small bowel. BetweenSeptember 1992 and March 1995, we performed laparoscopic procedures in 35patients with acute occlusion of the small bowel. The preoperative work-up highly suggestive of adhesion. There were 17 males and 18 females, mean age 48.2 years. In 30 patients, the operation confirmed the preoperative diagnosis of occlusion by adhesions. Lysis was performed entirely via the laparoscopic route in 21 of the 30 patients (70%). Immediate postoperative complications were 3 bowel lesions. Intestinal mobility was re-established in 1.8 days after operation and the mean duration of hospitalization was 5days for patients with laparoscopic procedure alone compared with 3.4 daysfor intestinal mobility and 10.4 days hospitalization for the 9 patients who were converted to laparotomy. An eventration of the trocar orifice occurred late in one patient and ischaemic stenosis of the bowel required laparotomy in another. There were no deaths. Laparoscopic treatment of adhesion occlusions is a feasible operation. Morbidity is low in experienced hands.The immediate benefit is rapid intestinal mobility and shorter hospita lstay. ============================================================================ ======
Benoist S, De Watteville JC, Gayral F[Role of celioscopy in acute obstructions of the small intestine Service de Chirurgie Generale et Digestive, CHU de Bicetre, LeKremlin-Bicetre. Gastroenterol Clin Biol 1996;20(4):357-61
SUMMARY:OBJECTIVES--The aim of this study was to evaluate the possibilities oflaparoscopy in the diagnosis and treatment of acute small bowel obstruction.METHODS--Thirty five patients, with less than three abdominal incisions, whohad undergone initial laparoscopy for acute small bowel obstruction, werereviewed. The small bowel was mobilized to determine the cause and site ofobstruction. RESULTS--In 31 cases, small bowel obstruction was caused by asingle or numerous obstructing bands. Among 31 cases of adhesions,laparoscopic treatment of intestinal obstruction was possible in 16 cases(51.6%). In 15 cases, laparoscopy had to be completed by laparotomy:numerous adhesions could not be divided in 12 cases; intestinal ischemiawhich required resection was present in 3 cases. There was no hospitalmortality and postoperative complications occurred in 19% of cases.Multivariate analysis demonstrated a relation between need to completelaparoscopy by laparotomy and two factors : presence of signs of peritonealirritation (P < 0.05) and intestinal obstruction caused by numerousadhesions or bands (P < 0.05). Mean hospital stay and postoperative ileuswere significantly shorter in the "laparoscopy" group than in the"laparoscopy + laparotomy" group. CONCLUSIONS--Laparoscopic treatment of acute small bowel obstruction is difficult and was possible in only half ofthe cases. The first port should be inserted by open technique to avoid therisk of perforation of distented small bowel. When laparoscopy shows numerous adhesions, laparoscopic treatment should not be pursued, andlaparotomy should be recommended to avoid the risk of visceral perforation. ========================================================================
Federmann G, Walenzyk J, Schneider A, Bauermeister G, Scheele C Laparoscopic therapy of mechanical or adhesion ileus of the small intestine--preliminary results Chirurgische Klinik, Kreiskrankenhaus Volklingen.Zentralbl Chir 1995;120(5):377-81
SUMMARY:Small bowel ileus is often caused by adhesions and might be treated by laparoscopic adhesiolysis. Therefore we tried to select those cases of ileus by anamnesis, clinical investigation, sonography and X-ray scan. 25 out of74 patients with small bowel ileus were supposed to have ileus caused by adhesions and were further diagnosed by laparoscopy: 15 patients wereoperated laparoscopically, 5 were operated conventionally after diagnostic laparoscopy and 3 converted into open operation after laparoscopic start (conversion rate 12%). 2 patients showed ileus due to gastrointestinal infection without necessity of operation. Out of 49 (66.2%) ileus-patients operated conventionally 5 might have been operated laparoscopically. Thus,15 of our patients with ileus of the small bowel (20.3%) were treated laparoscopically. Based on these results we suppose that following a properselection about 25% of small bowel ileus can be treated adequately bylaparoscopic adhesiolysis =======================================================================
Jorgensen JO, Lalak NJ, Hunt DR Is laparoscopy associated with a lower rate of postoperative adhesions thanlaparotomy? A comparative study in the rabbit. Laparoscopic Research Unit, St George Hospital, Sydney, New South Wales,Australia. Aust N Z J Surg 1995 May;65(5):342-4
SUMMARY:This trial set out to test the hypothesis that there is no difference in the incidence of intra-abdominal adhesions after a stereotyped intraperitoneal injury created via laparoscopy or laparotomy. Twenty New Zealand Whiterabbits had a 2 x 2 cm area of peritoneum stripped off their caecum andadjacent parietal peritoneum, either by laparotomy or laparoscopy. Outcome was assessed by the incidence of adhesions to the test site and the wound.There was no difference in the rate of adhesions at the test site in the two groups. The rate of adhesions to the wound was different in the two groups(70% laparotomy, 0% laparoscopy; P = 0.003). In a rabbit model, comparing laparoscopy and laparotomy in a strictly controlled operative environment, a stereotyped intraperitoneal injury results in similar rates of postoperative adhesions. Laparoscopy is, however, associated with a much lower incidence of wound adhesion. The potential for postoperative adhesions is real after laparoscopic surgery.
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