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| courtesy: laparoscopyindia.com |
At present,
there is little evidence to support the routine use of adhesiolysis to relieve
post-operative chronic abdominal pain after gynecological and general surgery
according to results of a systematic review and meta-analysis published in
current issue of Journal of Human Reproduction Update.
Postoperative
adhesions are cause of significant morbidity like bowel obstruction, chronic
pelvic pain and infertility in females. Open gynecological surgeries are
highest risk factor for adhesions formation.
Chronic pain
leads to diminished quality of life post operatively and affects nearly 20-40%
of patients who have undergone abdominal surgeries.
This systematic
review and meta-analysis investigated the role of surgery in relieving the
chronic pain immediately and after extended follow up. It also assessed the
safety and complications associated with adhesiolysis.
After
literature review a total of 4294 unique studies were identified, out of which
13 studies met the study criteria which included 2 RCTs.
After the
pooled analysis of the data, 72% patients reported improvement in pain at
follow-up of > 3 months. In about 20% of the patients no cause of pain was
found while 4% patients suffered some complications because of laparoscopy.
The authors
concluded that laparoscopic adhesiolysis relieves pain from adhesions in ~70%
of patients for short term only. The evidence does not support adhesiolysis for
relieving chronic pain in longer run. It also results in bowel injuries and
many laparoscopies turn out to be negative amounting to unnecessary surgeries.
More
research should be focused at techniques and materials designed to reduce and
prevent postsurgical adhesions and to improve results of adhesiolysis.
How best to diagnose adhesion in a postoperative case who reports with CPP-Pelvic pain with other conventional noninvasive investigations turns out to be negative? In any case, in my opinion to establish the very diag of Post op adhesion, quite often we have to resort to-Diag Lap. What is his consensus of Forum members-in this regard? If diag Lap is contemplated-should we refrain from adhesiolysis??
ReplyDeleteThanks, Dr.Pal. I think each case has to be decided upon individual basis. The results of the meta-analysis does insist that the analysis did not find any evidence to advocate adhesiolysis as a routine surgical procedure in cases of all cases of postoperative chronic pain. We have to put more research into refining preoperative diagnostic procedures to avoid unnecessary surgeries.
DeleteGreat info! I recently came across your blog and have been reading along. I thought I would leave my first comment. I don’t know what to say except that I have. Dr. HE Schlauchmagen Op Türkei
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