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ORIGINAL ARTICLE
Year : 2019  |  Volume : 32  |  Issue : 2  |  Page : 499-505

The role of laparoscopic adhesiolysis in the treatment of patients with recurrent, adhesive intestinal obstruction Menoufia Medical Journal


1 Department of General Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of General Surgery, Damanhour Medical National Institute, Damanhour, El Beheira Governorate, Egypt

Correspondence Address:
Mohamed A Dorbok
Department of General Surgery, Damanhour Medical National Institute, Damanhour 22516, El Beheira Governorate
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_688_17

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Objective The aim of this study was to assess the role of laparoscopic adhesiolysis in the treatment of patients with recurrent attacks of adhesive intestinal obstruction. Background Adhesive intestinal obstruction represents a common clinical problem following abdominal surgery with a high recurrence rate. Once adhesion has formed, its only means of elimination is operative adhesiolysis. Theoretically, adhesiolysis performed through a laparoscope is expected to provide better outcomes than the conventional open procedure. Patients and methods This is a prospective study that was done on a consecutive sample of 20 patients who were admitted to Menoufia University Hospital and Damanhour Medical National Institute during the period between April 2016 and February 2017 with recurrent postoperative adhesive intestinal obstruction that improved with conservative management. Exclusion criteria were peritonitis, severe abdominal distension, pregnancy, liver diseases, and previously confirmed or strongly suspected abdominal malignancy. All patients had undergone elective laparoscopic adhesiolysis after obtaining informed consent. Patients were followed up for 6 months. The complications and the outcome of the operation were recorded. Results Postoperative adhesions were identified laparoscopically in all patients. In the majority of cases (80%), the location of adhesions was distal to the lower abdomen. Successful complete laparoscopic adhesiolysis was feasible in 18 (90%) patients. Conversion to laparotomy was required for two (10%) patients because of intestinal perforation (n = 1) or a convoluted mass of adherent bowel (n = 1). One recurrence of intestinal obstruction was noted over a follow-up period of 6 months and improved with conservative management. Conclusion Laparoscopic adhesiolysis for recurrent postoperative adhesive bowel obstruction is feasible and safe, with a high success rate in experienced hands and results in minimal perioperative morbidity.


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