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Park SH, Lee CM, Hur H, Min JS, Ryu SW, Son YG, Chae HD, Jeong O, Jung MR, Choi CI, Song KY, Lee HH, Kim HG, Jee YS, Hwang SH, Lee MS, Kim KH, Seo SH, Jeong IH, Son MW, Kim CH, Yoo MW, Oh SJ, Kim JG, Hwang SH, Choi SI, Yang KS, Huang H, Park S. Totally laparoscopic versus laparoscopy-assisted distal gastrectomy: the KLASS-07: a randomized controlled trial. Int J Surg 2024; 110:4810-4820. [PMID: 38716987 PMCID: PMC11325945 DOI: 10.1097/js9.0000000000001543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/15/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUNDS Strong evidence is lacking as no confirmatory randomized controlled trials (RCTs) have compared the efficacy of totally laparoscopic distal gastrectomy (TLDG) with laparoscopy-assisted distal gastrectomy (LADG). The authors performed an RCT to confirm if TLDG is different from LADG. METHODS The KLASS-07 trial is a multi-centre, open-label, parallel-group, phase III, RCT of 442 patients with clinical stage I gastric cancer. Patients were enroled from 21 cancer care centres in South Korea between January 2018 and September 2020 and randomized to undergo TLDG or LADG using blocked randomization with a 1:1 allocation ratio, stratified by the participating investigators. Patients were treated through R0 resections by TLDG or LADG as the full analysis set of the KLASS-07 trial. The primary endpoint was morbidity within postoperative day 30, and the secondary endpoint was quality of life (QoL) for 1 year. This trial is registered at ClinicalTrials.gov (NCT03393182). RESULTS Four hundred forty-two patients were randomized (222 to TLDG, 220 to LADG), and 422 patients were included in the pure analysis (213 and 209, respectively). The overall complication rate did not differ between the two groups (TLDG vs. LADG: 12.2% vs. 17.2%). However, TLDG provided less postoperative ileus and pulmonary complications than LADG (0.9% vs. 5.7%, P= 0.006; and 0.5% vs. 4.3%, P= 0.035, respectively). The QoL was better after TLDG than after LADG regarding emotional functioning at 6 months, pain at 3 months, anxiety at 3 and 6 months, and body image at 3 and 6 months (all P< 0.05). However, these QoL differences were resolved at 1 year. CONCLUSIONS The KLASS-07 trial confirmed that TLDG is not different from LADG in terms of postoperative complications but has the advantages to reduce ileus and pulmonary complications. TLDG can be a good option to offer better QoL in terms of pain, body image, emotion, and anxiety at 3-6 months.
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Affiliation(s)
- Shin-Hoo Park
- Department of Surgery, Korea University College of Medicine
- Division of Foregut Surgery, Korea University Anam Hospital
- Department of Surgery, Uijeongbu Eulji Medical Centre, Eulji University College of Medicine
| | - Chang-Min Lee
- Department of Surgery, Korea University College of Medicine
- Department of Surgery, Korea University Ansan Hospital, Ansan
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon
| | - Jae-Seok Min
- Department of Surgery, Korea University College of Medicine
- Department of Surgery, Uijeongbu Eulji Medical Centre, Eulji University College of Medicine
- Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Cancer Centre
| | - Seung Wan Ryu
- Department of Surgery, Keimyung University Dongsan Medical Centre
| | - Young-Gil Son
- Department of Surgery, Keimyung University Dongsan Medical Centre
| | - Hyun Dong Chae
- Department of Surgery, Catholic University of Daegu School of Medicine, Daegu
| | - Oh Jeong
- Department of Surgery, Chonnam National University Medical School, Jeollanam-do
| | - Mi Ran Jung
- Department of Surgery, Chonnam National University Medical School, Jeollanam-do
| | - Chang In Choi
- Department of Surgery, Pusan National University School of Medicine, Pusan
| | | | | | - Ho Goon Kim
- Department of Surgery, Chonnam National University Medical School, Gwangju
| | - Ye Seob Jee
- Department of Surgery, Dankook University College of Medicine, Cheonan
| | - Sun-Hwi Hwang
- Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan
| | - Moon-Soo Lee
- Department of Surgery, Eulji University Hospital, Daejeon
| | - Kwang Hee Kim
- Department of Surgery, Busan Paik Hospital, Inje University, Gimhae
| | - Sang Hyuk Seo
- Department of Surgery, Busan Paik Hospital, Inje University, Gimhae
| | - In Ho Jeong
- Department of Surgery, Jeju National University School of Medicine, Jeju
| | - Myoung Won Son
- Department of Surgery, Soonchunhyang University Hospital Cheonan, Cheonan, Korea
| | | | - Moon-Won Yoo
- Department of Surgery, Asan Medical Centre, University of Ulsan College of Medicine
| | - Sung Jin Oh
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan
| | - Jeong Goo Kim
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Seong Ho Hwang
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Sung Il Choi
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul
| | - Kyung Sook Yang
- Department of Biostatistics, Korea University College of Medicine
| | - Hua Huang
- Department of Gastric Surgery, Fudan University Shanghai Cancer Centre
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Sungsoo Park
- Department of Surgery, Korea University College of Medicine
- Department of Surgery, Uijeongbu Eulji Medical Centre, Eulji University College of Medicine
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Honjo K, Kawai M, Tsuchiya Y, Ro H, Sugimoto K, Takahashi M, Tomiki Y, Sakamoto K. Risk factors for small-bowel obstruction after colectomy for colorectal cancer: a retrospective study. Surg Today 2023; 53:1038-1046. [PMID: 36949236 DOI: 10.1007/s00595-023-02674-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/31/2022] [Indexed: 03/24/2023]
Abstract
PURPOSE Postoperative adhesions are a concerning complication of abdominal surgery with major implications on quality of life. This study aimed to investigate the risk factors for postoperative small-bowel obstruction (SBO) after colectomy for colorectal cancer. METHODS We reviewed the clinicopathological variables of 1646 patients who underwent colectomy for colorectal cancer between 2009 and 2018. RESULTS SBO occurred following primary tumor resection for colorectal cancer in 67 (4.1%) of the 1646 patients. The median observation period was 7.5 (range: 3.0-12.0) years. Multivariate analysis revealed that rectal tumors, anastomotic leakages, previous abdominal surgeries, and longer operating times were all correlated with postoperative SBO, but there were no differences in the incidence of SBO between laparoscopic vs. open surgery. The use of adhesion prevention material had no effect on SBO. Our data showed that the onset of SBO tended to be relatively early, within a year after surgery (89.5%). CONCLUSIONS Tumor localization in the rectum is associated with several problems, including a wide resection area, prolonged operative duration, and high risk of anastomotic leakage, which may increase the risk of SBO. Laparoscopic surgery and adhesion prevention material did not demonstrate a clear preventive effect against SBO.
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Affiliation(s)
- Kumpei Honjo
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Masaya Kawai
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yuki Tsuchiya
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hisashi Ro
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kiichi Sugimoto
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Makoto Takahashi
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yuichi Tomiki
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kazuhiro Sakamoto
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Sueda T, Tei M, Nishida K, Yoshikawa Y, Matsumura T, Koga C, Miyagaki H, Tsujie M, Akamaru Y, Hasegawa J. Impact of prior abdominal surgery on short-term outcomes following laparoscopic colorectal cancer surgery: a propensity score-matched analysis. Surg Endosc 2022; 36:4429-4441. [PMID: 34716479 DOI: 10.1007/s00464-021-08794-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 10/17/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Whether laparoscopic surgery after prior abdominal surgery (PAS) is safe and feasible for colorectal cancer (CRC) remains controversial. The present study aimed to evaluate the impact of PAS on short-term outcomes following laparoscopic CRC surgery. METHODS We performed retrospective analysis used propensity score-matched analysis to reduce the possibility of selection bias. Participants comprised 1284 consecutive patients who underwent elective laparoscopic CRC surgery between 2010 and 2020. Patients were divided into two groups according to PAS. Patients with PAS were then matched to patients without these conditions. Short-term outcomes were evaluated between groups in the overall cohort and matched cohort, and risk factors for conversion to laparotomy and severe postoperative complications were analyzed. RESULTS After propensity score matching, we enrolled 762 patients (n = 381 in each group). Before matching, significant group-dependent differences were observed in sex, age, primary tumor site, pathological (p) T stage, and type of procedure. No significant difference was found between groups in terms of rate of conversion to laparotomy, estimated blood loss, rate of extended resection, length of postoperative stay, and postoperative complications. After matching, estimated operative time was significantly longer in the PAS group (p = 0.01). Significant differences were found between groups in terms of reason for conversion to laparotomy. Multivariate analyses identified significant risk factors for conversion to laparotomy as pT stage ≥ 3 (odds ratio [OR] 2.36; 95% confidence interval [CI] 1.05-5.26) and body mass index ≥ 25 kg/m2 (OR 3.56; 95% CI 1.07-11.7). Multivariate analyses identified rectum in the primary tumor site as the only significant risk factor for severe postoperative complications (OR 2.37; 95% CI 1.08-5.20). CONCLUSIONS Laparoscopic CRC surgery after PAS showed acceptable short-term outcomes compared to Non-PAS. The laparoscopic approach appears safe and feasible for CRC regardless of whether the patient has a history of PAS.
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Affiliation(s)
- Toshinori Sueda
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-kitaku, Sakai, Osaka, 591-8025, Japan.
| | - Mitsuyoshi Tei
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-kitaku, Sakai, Osaka, 591-8025, Japan
| | - Kentaro Nishida
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-kitaku, Sakai, Osaka, 591-8025, Japan
| | - Yukihiro Yoshikawa
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-kitaku, Sakai, Osaka, 591-8025, Japan
| | - Tae Matsumura
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-kitaku, Sakai, Osaka, 591-8025, Japan
| | - Chikato Koga
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-kitaku, Sakai, Osaka, 591-8025, Japan
| | - Hiromichi Miyagaki
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-kitaku, Sakai, Osaka, 591-8025, Japan
| | - Masanori Tsujie
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-kitaku, Sakai, Osaka, 591-8025, Japan
| | - Yusuke Akamaru
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-kitaku, Sakai, Osaka, 591-8025, Japan
| | - Junichi Hasegawa
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-kitaku, Sakai, Osaka, 591-8025, Japan
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Yahagi M, Ishii Y, Ochiai H, Sako H, Maeda H, Takemura Y, Oka T, Soutome K, Kamiya N, Watanabe M. Usefulness of laparoscopic surgery and preoperative examinations for chronic recurrent small bowel obstruction. Surg Today 2021; 51:807-813. [PMID: 33423108 DOI: 10.1007/s00595-020-02197-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/09/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to investigate the usefulness of laparoscopic surgery for patients with postoperative abdominal symptoms, including chronic recurrent small-bowel obstruction (SBO), and preoperative examinations of barium follow-through and computed tomography (CT) to predict the postoperative outcomes of laparoscopic surgery. METHODS Between 2016 and 2018, 49 patients with postoperative symptoms were treated by laparoscopic surgery at our institute. The data from two preoperative examinations were available for 42 patients. The patients were divided into 4 groups: CT-positive (CP, n = 18), barium follow-through-positive (BP, n = 1), both positive (AP [all positive] n = 13), and both negative (AN [all negative], n = 10). RESULTS Among the 49 patients, 41 received pure laparoscopic surgery, 7 received laparoscopic-assisted surgery with mini-laparotomy, and 1 required conversion. Intra- and postoperative complications occurred in two and seven patients, respectively. Improvement of abdominal symptoms was observed in 40 patients. In terms of the medium-term outcomes, the rate of improvement of symptoms was poorer in the AN group than in the other three groups, but not to a significant degree. CONCLUSION Laparoscopic surgery was safe and feasible for patients with chronic recurrent abdominal symptoms, including SBO. Furthermore, in patients with negative results on both preoperative examinations, laparoscopic surgery may yield only poor improvement of symptoms.
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Affiliation(s)
- Masashi Yahagi
- Department of Surgery, Kitasato University Kitasato Institute Hospital, Shirokane 5-9-1, Minato-ku, Tokyo, 108-8642, Japan
| | - Yoshiyuki Ishii
- Department of Surgery, Kitasato University Kitasato Institute Hospital, Shirokane 5-9-1, Minato-ku, Tokyo, 108-8642, Japan. .,Department of Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan.
| | - Hiroki Ochiai
- Department of Surgery, Kitasato University Kitasato Institute Hospital, Shirokane 5-9-1, Minato-ku, Tokyo, 108-8642, Japan
| | - Hiroyuki Sako
- Department of Surgery, Kitasato University Kitasato Institute Hospital, Shirokane 5-9-1, Minato-ku, Tokyo, 108-8642, Japan
| | - Hinako Maeda
- Department of Surgery, Kitasato University Kitasato Institute Hospital, Shirokane 5-9-1, Minato-ku, Tokyo, 108-8642, Japan
| | - Yusuke Takemura
- Department of Surgery, Kitasato University Kitasato Institute Hospital, Shirokane 5-9-1, Minato-ku, Tokyo, 108-8642, Japan
| | - Taishu Oka
- Department of Surgery, Kitasato University Kitasato Institute Hospital, Shirokane 5-9-1, Minato-ku, Tokyo, 108-8642, Japan
| | - Keiichi Soutome
- Department of Surgery, Kitasato University Kitasato Institute Hospital, Shirokane 5-9-1, Minato-ku, Tokyo, 108-8642, Japan
| | - Noriki Kamiya
- Department of Surgery, Kitasato University Kitasato Institute Hospital, Shirokane 5-9-1, Minato-ku, Tokyo, 108-8642, Japan.,Department of Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan
| | - Masahiko Watanabe
- Department of Surgery, Kitasato University Kitasato Institute Hospital, Shirokane 5-9-1, Minato-ku, Tokyo, 108-8642, Japan
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Comba C, Salik AE, Demirayak G, Erdogan SV, Sacan F, Ozdemir IA. Comparison of Postoperative Benign Pelvic Cysts Occurred after Gynecologic or Gyne-oncologic Surgery Treated with Percutaneous Transcatheteric Sclerosant Alcohol Therapy. Gynecol Minim Invasive Ther 2020; 9:198-203. [PMID: 33312862 PMCID: PMC7713659 DOI: 10.4103/gmit.gmit_107_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 04/16/2019] [Accepted: 06/15/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives: Here, we compare the success of percutaneous transcatheter sclerosant alcohol therapy (PTSAT) for the postoperative treatment of benign pelvic cysts that occurred after gynecologic surgery. Materials and Methods: The study is a retrospective case–control trial. Gynecological patients who had symptoms due to postoperative pelvic cysts and received PTSAT after gynecologic surgery, between October 2008 and January 2018, were examined in a single training and research hospital in Turkey. Some factors were investigated for associations with postoperative pelvic cyst formation in patients who underwent gynecologic operations for malignancies or benign conditions. Statistical analysis used: The association between two independent and nonnormally distributed continuous variables was analyzed with the Mann–Whitney U-test. Spearman's rho correlation analysis was conducted to determine the correlation of two nonnormally distributed variables. Chi-square (or Fisher's exact test, when more suitable) was used to examine the correlation between categorical variables. Results: Statistically significant differences were found in terms of the average age was higher in patients with malignancies, and the average postoperative pelvic cyst detection time was higher in patients with benign pelvic cysts. While all patients were treated with PTSAT, repetitive PTSAT was required for seven benign and ten malign cases. Conclusion: Patients with pelvic cysts that occurred after gynecologic surgery for malignant conditions, large volume pelvic cysts and patients with benign cysts who underwent more than one surgery required recurrent PTSAT.
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Affiliation(s)
- Cihan Comba
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, University of Health Sciences, Sultangazi Haseki Training and Research Hospital, Istanbul, Turkey
| | - Aysun Erbahceci Salik
- Department of Interventional Radiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Gokhan Demirayak
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Sakir Volkan Erdogan
- Department of Gynecology and Obstetrics, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Filiz Sacan
- Department of Interventional Radiology, Acıbadem Altunizade Hospital, Istanbul, Turkey
| | - Isa Aykut Ozdemir
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Medipol Mega University Hospital, Istanbul, Turkey
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Zhao J, Samaan JS, Toubat O, Samakar K. Laparoscopy as a Diagnostic and Therapeutic Modality for Chronic Abdominal Pain of Unknown Etiology: A Literature Review. J Surg Res 2020; 252:222-230. [PMID: 32289579 DOI: 10.1016/j.jss.2020.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/14/2020] [Accepted: 03/08/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Investigate the diagnostic and therapeutic utility of laparoscopy in the management of patients with chronic abdominal pain of unknown origin. METHODS Ovid MEDLINE, PubMed, and SCOPUS databases were queried to identify relevant published studies. Data on the diagnostic and therapeutic utility of laparoscopy were abstracted and summarized. RESULTS Laparoscopy achieved a diagnosis in 65% to 94% of patients with chronic abdominal pain of unknown origin. Common intraoperative findings included adhesions, chronic appendicitis, hernias, and enlarged mesenteric lymph nodes. These findings corresponded with the therapeutic procedures that were performed, including laparoscopic adhesiolysis, appendectomy, and hernia repair. Therapeutic utility of laparoscopy based on pain relief, patient satisfaction, and quality of life ranged from 63% to 94%. CONCLUSIONS Based on current available evidence, diagnostic laparoscopy (DL) is a safe and effective method for identifying organic causes of chronic abdominal pain. Laparoscopic treatment also resulted in substantial pain relief for a majority of patients. However, the efficacy of laparoscopic adhesiolysis remains controversial. We would recommend the use of DL as an early diagnostic tool, but more robust studies are needed to establish the breadth of its therapeutic utility in clinical practice.
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Affiliation(s)
- Jasmine Zhao
- Division of Upper GI and General Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Jamil S Samaan
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California
| | - Omar Toubat
- Division of Upper GI and General Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Kamran Samakar
- Division of Upper GI and General Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
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Farag S, Padilla PF, Smith KA, Sprague ML, Zimberg SE. Management, Prevention, and Sequelae of Adhesions in Women Undergoing Laparoscopic Gynecologic Surgery: A Systematic Review. J Minim Invasive Gynecol 2018; 25:1194-1216. [DOI: 10.1016/j.jmig.2017.12.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/11/2017] [Accepted: 12/17/2017] [Indexed: 01/09/2023]
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How to Understand the Complexity of Endometriosis-Related Pain. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2017. [DOI: 10.5301/je.5000271] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Pain is the most important symptom in patients with endometriosis, and its management is truly challenging. Due to the different localization of the endometriotic lesions in the pelvis, patients suffer from visceral and somatic pain or both at the same time. There are specific and unspecific symptoms characterized by endometriosis. Specific symptoms include dysmenorrhea, cyclic and acyclic pelvic pain, dyschezia, dysuria and dyspareunia. There is also a wide range of unspecific symptoms, such as unspecific bowel and bladder complaints, the emission of pain in the legs, vegetative concomitants like vomiting, emesis, gastric disorders, headaches, dizziness, painful ovulation, irregular pelvic pain, lower back pain, chronic fatigue. These symptoms can be both cyclic and acyclic, and in most cases, they are permanent. Visceral and somatic pain are completely different pain subtypes and can therefore be an explanation for the wide variety of symptoms. The close interaction between visceral sensory nerve fibers and the autonomic ganglia explain the high rate of concomitant vegetative reactions, such as vomiting and orthostatic dysregulation. In general, pain generation is a complex interplay of peripheral and central sensitization mechanisms. Accordingly, the pain produced in endometriotic lesions is the result of mediating substances, nerve fibers, cytokine-releasing immune cells and macrophages synthesis. These interactions seem to stimulate the neurogenic inflammatory process and sensitization of the peripheral nerves. Furthermore, the disruption of the input on the level of the spinal cord and the recognition of the pain in the brain may lead to exaggerated responses known as central hyperalgesia. Hormones and psychological factors influence the pain sensation and make the status of each patient very individual. Consequently, the involvement of professional pain management along with an implementation of pain-coping strategies in the patient's everyday life are obligatory in chronic pain situations. An additional osteopathic treatment with a manual resolve of muscle blockades to avoid secondary “pain intensifying” changes of the pelvic floor (tension) or malposition through relieving posture, is also recommended. Pain management in patients with endometriosis is very complex and requires an individual treatment strategy for each patient to avoid unnecessary surgical procedures. This information proves that it is hard to break the cycle of pain when chronic pain syndrome is already apparent.
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Impact of Prior Abdominal Surgery on Rates of Conversion to Open Surgery and Short-Term Outcomes after Laparoscopic Surgery for Colorectal Cancer. PLoS One 2015. [PMID: 26207637 PMCID: PMC4514825 DOI: 10.1371/journal.pone.0134058] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Purpose To evaluate the impact of prior abdominal surgery (PAS) on rates of conversion to open surgery and short-term outcomes after laparoscopic surgery for colon and rectal cancers. Methods We compared three groups as follows: colon cancer patients with no PAS (n = 272), major PAS (n = 24), and minor PAS (n = 33), and rectal cancer patients with no PAS (n = 282), major PAS (n=16), and minor PAS (n = 26). Results In patients with colon and rectal cancers, the rate of conversion to open surgery was significantly higher in the major PAS group (25% and 25%) compared with the no PAS group (8.1% and 8.9%), while the conversion rate was similar between the no PAS and minor PAS groups (15.2% and 15.4%). The 30-day complication rate did not differ among the three groups (28.7% and 29.1% in the no PAS group, 29.2% and 25% in the major PAS group, and 27.3% and 26.9% in the minor PAS group). The mean operative time did not differ among the three groups (188 min and 227 min in the no PAS group, 191 min and 210 min in the major PAS group, and 192 min and 248 min in the minor PAS group). The rate of conversion to open surgery was significantly higher in patients with prior gastrectomy or colectomy compared with the no PAS group, while the conversion rate was similar between the no PAS group and patients with prior radical hysterectomy in patients with colon and rectal cancers. Conclusions Our results suggest that colorectal cancer patients with minor PAS or patients with prior radical hysterectomy can be effectively managed with a laparoscopic approach. In addition, laparoscopy can be selected as the primary surgical approach even in patients with major PAS (prior gastrectomy or colectomy) given the assumption of a higher conversion rate.
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Gerner-Rasmussen J, Burcharth J, Gögenur I. The efficacy of adhesiolysis on chronic abdominal pain: a systematic review. Langenbecks Arch Surg 2015; 400:567-76. [DOI: 10.1007/s00423-015-1316-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 06/10/2015] [Indexed: 01/09/2023]
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Huang YH, Chao A, Chao AS, Wang CJ. Laparoscopic adhesiolysis and marsupialization of a rapidly progressing pelvic pseudocyst. Taiwan J Obstet Gynecol 2013; 51:455-7. [PMID: 23040938 DOI: 10.1016/j.tjog.2012.07.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2012] [Indexed: 11/16/2022] Open
Affiliation(s)
- Yu-Hsin Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei, Taiwan
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Choi HJ, Yoon SC, Kim YJ. Two Cases of Laparoscopic Adhesiolysis for Chronic Abdominal Pain without Intestinal Obstruction after Total Gastrectomy. J Gastric Cancer 2013; 12:249-53. [PMID: 23346498 PMCID: PMC3543976 DOI: 10.5230/jgc.2012.12.4.249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 11/03/2012] [Accepted: 11/03/2012] [Indexed: 11/20/2022] Open
Abstract
Chronic abdominal pain remains a challenge to all known diagnostic and treatment methods with patients undergoing numerous diagnostic work-ups including surgery. However, the surgical treatment of patients with chronic intractable abdominal pain is controversial. There has been no discussion of the indications for adhesiolysis in cases of obstruction or strangulation of the bowel, and adhesiolysis by laparotomy has never gained acceptance as a treatment modality for chronic abdominal pain. One of the reasons for this lack of acceptance is the high complication rate during and after adhesiolysis. Laparoscopic surgery has been accepted as a technique for diagnostic and therapeutic procedures in general surgery. Laparoscopy allows surgeons to see and treat many abdominal changes that could not otherwise be diagnosed. Here we report two cases of successful symptomatic improvement through laparoscopic adhesiolysis for chronic abdominal pain without intestinal obstruction after total gastrectomy.
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Affiliation(s)
- Hyun Jung Choi
- Department of Surgery, Soonchunhyang University College of Medicine, Seoul, Korea
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ten Broek R, Kok- Krant N, Bakkum E, Bleichrodt R, van Goor H. Different surgical techniques to reduce post-operative adhesion formation: a systematic review and meta-analysis. Hum Reprod Update 2012; 19:12-25. [DOI: 10.1093/humupd/dms032] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Ouaïssi M, Gaujoux S, Veyrie N, Denève E, Brigand C, Castel B, Duron JJ, Rault A, Slim K, Nocca D. Post-operative adhesions after digestive surgery: their incidence and prevention: review of the literature. J Visc Surg 2012; 149:e104-14. [PMID: 22261580 DOI: 10.1016/j.jviscsurg.2011.11.006] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Post-operative adhesions after gastrointestinal surgery are responsible for significant morbidity and constitute an important public health problem. The aim of this study was to review the surgical literature to determine the incidence, consequences and the variety of possible countermeasures to prevent adhesion formation. METHODS A systematic review of English and French language surgical literature published between 1995 and 2009 was performed using the keywords "adhesion" and "surgery". RESULTS Peritoneal adhesions are reported as the cause of 32% of acute intestinal obstruction and 65-75% of all small bowel obstructions. It is estimated that peritoneal adhesions develop after 93-100% of upper abdominal laparotomies and after 67-93% of lower abdominal laparotomies. Nevertheless, only 15-18% of these adhesions require surgical re-intervention. The need for re-intervention for adhesion-related complications varies depending on the initial type of surgery, the postoperative course and the type of incision. The laparoscopic approach appears to decrease the risk of adhesion formation by 45% and the need for adhesion-related re-intervention to 0.8% after appendectomy and to 2.5% after colorectal surgery. At the present time, only one product consisting of hyaluronic acid applied to a layer of carboxymethylcellulose (Seprafilm(®)) has been shown to significantly reduce the incidence of postoperative adhesion formation; but this product is also associated with a significant increase in the incidence of anastomotic leakage when the membrane is applied in direct contact with the anastomosis. The use of this product has not been shown to decrease the risk of re-intervention for bowel obstruction. CONCLUSIONS The prevention of postoperative adhesions is an important public health goal, particularly in light of the frequency of this complication. The routine use of anti-adhesion products is not recommended given the lack of studies with a high level of evidence concerning their efficacy and safety of use.
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Affiliation(s)
- M Ouaïssi
- Service de chirurgie digestive et viscérale, hôpital Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
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ten Broek RPG, Kok-Krant N, Verhoeve HR, van Goor H, Bakkum EA. Efficacy of polyethylene glycol adhesion barrier after gynecological laparoscopic surgery: Results of a randomized controlled pilot study. ACTA ACUST UNITED AC 2011; 9:29-35. [PMID: 22408577 PMCID: PMC3285763 DOI: 10.1007/s10397-011-0698-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 08/11/2011] [Indexed: 12/30/2022]
Abstract
Postoperative adhesions are the most frequent complication of peritoneal surgery, causing small bowel obstruction, female infertility and chronic pain. This pilot study assessed the efficacy of a sprayable polyethylene glycol (PEG) barrier in the prevention of de novo adhesions. 16 patients undergoing laparoscopic gynecological surgery were randomly assigned by shuffled sealed envelopes to receive either the adhesion barrier or no adhesion prevention. Incidence and severity of adhesions were scored at eight sites in the pelvis and reassessed by second look laparoscopy. Adhesion prevention was considered successful if no de novo adhesion were found at second look laparoscopy. One patient was excluded before randomization. Nine patients were randomized to treatment and six patients to control group. De novo adhesions were found in 0/9 patients who received the PEG barrier compared to 4/6 without adhesion prevention (0% vs. 67%, P = 0.01). Reduction in adhesion score was significantly greater in patients receiving PEG barrier (−2.6 vs. −0.06, P = 0.03). Meta-analysis of three randomized trials demonstrated that PEG barrier reduces the incidence of adhesions (odds ratio [OR] = 0.27; 95% CI 0.11–0.67). From this study, PEG barrier seems effective in reducing postoperative formation of de novo adhesions.
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Affiliation(s)
- R. P. G. ten Broek
- Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - N. Kok-Krant
- Department of Gynaecology and Obstetrics, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, 1090 HM Amsterdam, The Netherlands
| | - H. R. Verhoeve
- Department of Gynaecology and Obstetrics, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, 1090 HM Amsterdam, The Netherlands
| | - H. van Goor
- Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - E. A. Bakkum
- Department of Gynaecology and Obstetrics, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, 1090 HM Amsterdam, The Netherlands
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Awonuga AO, Fletcher NM, Saed GM, Diamond MP. Postoperative adhesion development following cesarean and open intra-abdominal gynecological operations: a review. Reprod Sci 2011; 18:1166-85. [PMID: 21775773 DOI: 10.1177/1933719111414206] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
In this review, we discuss the pathophysiology of adhesion development, the impact of physiological changes associated with pregnancy on markers of adhesion development, and the clinical implications of adhesion development following cesarean delivery (CD). Although peritoneal adhesions develop after the overwhelming majority of intra-abdominal and pelvic surgery, there is evidence in the literature that suggests that patients having CD may develop adhesions less frequently. However, adhesions continue to be a concern after CD, and are likely significant, albeit on average less than after gynecological operations, but with potential to cause significant delay in the delivery of the baby with serious, lifelong consequences. Appreciation of the pathophysiology of adhesion development described herein should allow a more informed approach to the rapidly evolving field of intra-abdominal adhesions and should serve as a reference for an evidence-based approach to consideration for the prevention and treatment of adhesions.
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Affiliation(s)
- Awoniyi O Awonuga
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI 48201, USA
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Abstract
Results of this study suggest that ultrasound can be used to quantitatively estimate the degree of adhesions between intestine and the abdominal wall. Background and Objectives: Laparoscopic treatment of incisional hernias reduces surgical traumas and postoperative pain. It requires intraperitoneal placement of a foreign body that might cause adhesions, leading to postoperative complications. The aim of this study was to improve reliability of ultrasound in quantitatively estimating adhesions to exploit the other advantages of ultrasound, such as availability and versatility. Methods: The ultrasound examination was performed by using a hand-held 3.5MHz curved linear probe. The image data were analyzed prior to scan conversion. Two square regions of interest were defined, one in the abdominal wall and one in the underlying bowels. A cross correlation-based algorithm tracked each region by using a time span of 3 frames. Subtracting the 2 displacement functions from each other yielded a relative displacement function, indicating the degree of bowel adhesions. This was compared with the intraoperative findings. Results and Conclusions: The method was proven to be a rapid and robust method for quantitatively estimating the degree of bowel adhesions. It is limited to evaluation of adhesions between bowel and abdominal wall. However, this ultrasound technique could assist in the safe placement of ports prior to redo laparoscopic surgery.
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Affiliation(s)
- Sebastien Muller
- SINTEF Health Research, 7465 Trondheim, Norway, Research Scientist, Dept. Medical Technology, 7465 Trondheim, Norway.
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Transvaginal rigid-hybrid natural orifice transluminal endoscopic surgery technique for anterior resection treatment of diverticulitis: a feasibility study. Surg Endosc 2011; 25:3034-42. [PMID: 21487875 DOI: 10.1007/s00464-011-1666-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 03/11/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND In laparoscopic anterior resection, minilaparotomy still is required. Recently, transvaginal hybrid natural orifice transluminal endoscopic surgery (NOTES) techniques for cholecystectomy have been described. Reports on operations that require removal of larger specimens, as in anterior resection, are scarce and limited primarily to small case series and case reports. The current study aimed to evaluate the feasibility and safety of transvaginal rigid-hybrid NOTES anterior resection (tvAR) for symptomatic diverticular disease. METHODS All female patients presenting with symptomatic diverticulitis of the sigmoid colon were candidates for inclusion in the study. The exclusion criteria specified failure to sign informed consent, previous colorectal resection, anesthesiologic contraindication for pneumoperitoneum, liver failure and coagulopathy, severe acute diverticular bleeding, internal fistula with abscess (Hinchey 2b), perforated diverticulitis with peritonitis (Hinchey 3 or 4), gynecologic or urologic contraindications, and absence of preoperative gynecologic examination. A preoperative and 2-week postoperative gynecologic examination was performed. Quality of life and sexual function were assessed preoperatively and 6 weeks postoperatively. RESULTS Of 70 patients, 45 (64.3%) were scheduled for tvAR. Five patients were withdrawn at the beginning of laparoscopy with no transvaginal access performed. Of the remaining 40 patients with attempted tvAR, 4 patients underwent conversion to a minilaparotomy (Pfannenstiel incision) and 2 patients were converted to a total median laparotomy. For 34 patients (85%), the operation was completed transvaginally. A total of 2 major complications and 10 minor complications occurred. No serious postoperative gynecologic morbidity was experienced. At 6 weeks postoperatively, sexual function did not differ significantly from preoperative status. CONCLUSIONS For symptomatic diverticular disease, TvAR is feasible, although the presented technique requires laparoscopic expertise and further refinement.
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ten Broek RPG, Wilbers J, van Goor H. Electrocautery causes more ischemic peritoneal tissue damage than ultrasonic dissection. Surg Endosc 2010; 25:1827-34. [PMID: 21140171 PMCID: PMC3109994 DOI: 10.1007/s00464-010-1474-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 11/11/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND Minimizing peritoneal tissue injury during abdominal surgery has the benefit of reducing postoperative inflammatory response, pain, and adhesion formation. Ultrasonic dissection seems to reduce tissue damage. This study aimed to compare electrocautery and ultrasonic dissection in terms of peritoneal tissue ischemia measured by microdialysis. METHODS In this study, 18 Wistar rats underwent a median laparotomy and had a peritoneal microdialysis catheter implanted in the left lateral sidewall. The animals were randomly assigned to receive two standard peritoneal incisions parallel to the catheter by either ultrasonic dissection or electrocautery. After the operation, samples of microdialysis dialysate were taken every 2 h until 72 h postoperatively for measurements of pyruvate, lactate, glucose, and glycerol, and ratios were calculated. RESULTS The mean lactate-pyruvate ratio (LPR), lactate-glucose ratio (LGR), and glycerol concentration were significantly higher in the electrocautery group than in the ultrasonic dissection group until respectively 34, 48, and 48 h after surgery. The mean areas under the curve (AUC) of LPR, LGR, and glycerol concentration also were higher in the electrocautery group than in the ultrasonic dissection group (4,387 vs. 1,639, P=0.011; 59 vs. 21, P=0.008; 7,438 vs. 4,169, P=0.008, respectively). CONCLUSION Electrosurgery causes more ischemic peritoneal tissue damage than ultrasonic dissection.
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Affiliation(s)
- Richard P. G. ten Broek
- Department of Surgery, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Joyce Wilbers
- Department of Surgery, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Pérez-Medina T, Álvarez J, Degollada M, de Santiago J, Lara A, Pascual A, Pérez Milán F, Crowe AM. Documento de consenso del Grupo de Trabajo sobre las Adherencias de la sección de endoscopia de la SEGO. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.pog.2010.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Roman H, Bourdel N, Canis M, Rigaud J, Delavierre D, Labat JJ, Sibert L. Adhérences et douleurs pelvipérinéales chroniques. Prog Urol 2010; 20:1003-9. [PMID: 21056378 DOI: 10.1016/j.purol.2010.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 08/16/2010] [Indexed: 11/26/2022]
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El-labban GM, Hokkam EN. The efficacy of laparoscopy in the diagnosis and management of chronic abdominal pain. J Minim Access Surg 2010; 6:95-9. [PMID: 21120065 PMCID: PMC2992668 DOI: 10.4103/0972-9941.72594] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Accepted: 07/01/2010] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Chronic abdominal pain is a difficult complaint. It leads to evident suffering and disability, both physically and psychologically. Many diagnostic and therapeutic procedures have been described in literature, but with little proof or evidence of success. Laparoscopy is one of the modalities that could be of benefit in such cases. We aim to evaluate the diagnostic and therapeutic value of laparoscopy in cases with chronic abdominal pain. MATERIALS AND METHODS Thirty patients with chronic abdominal pain were included in this prospective descriptive cross-sectional study. The pain in all patients was of unclear etiology despite all the investigative procedures. All patients were subjected to laparoscopic evaluation for their conditions. The findings and outcomes of the laparoscopy were recorded and analyzed. RESULTS The most common site of pain was the periumbilical region (30%). A definitive diagnosis was made in 25 patients (83.3%), while five patients (16.7%) had no obvious pathology. Adhesions were the most common laparoscopic findings (63.3%) followed by appendiceal pathology (10%), hernia (3.3%), gall bladder pathology (3.3%), and mesenteric lymphadenopathy (3.3%). Postoperatively, pain relief was achieved in 24 patients (80%) after two months. CONCLUSION Laparoscopy is an effective diagnostic and therapeutic modality in the management of patients with chronic abdominal pain.
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Affiliation(s)
- Gouda M El-labban
- Department of General Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Emad N Hokkam
- Department of General Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Nakajima J, Sasaki A, Otsuka K, Obuchi T, Nishizuka S, Wakabayashi G. Risk factors for early postoperative small bowel obstruction after colectomy for colorectal cancer. World J Surg 2010; 34:1086-90. [PMID: 20151126 DOI: 10.1007/s00268-010-0462-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Small bowel obstruction (SBO) after colectomy leads to markedly lower patient quality of life, longer hospital stays, and increased hospitalization costs. From a systemic treatment point of view, early postoperative SBO is one of the major concerns of the surgery because it often delays chemotherapy in advanced cases. The goal of this single-center study was to evaluate the risk factors for early postoperative SBO. METHODS Univariate and multivariate analyses were performed for 1,004 patients who underwent open colectomy (OC, 421 patients) or laparoscopic-assisted colectomy (LAC, 583 patients) for colorectal cancer between January 1997 and December 2008. RESULTS The overall early postoperative SBO were 45 cases (4.5%). Univariate analysis of the risk factors for early postoperative SBO showed no statistical significance between respective risk factors and occurrence of SBO for age >70 years, body mass index >25 kg/m(2), ASA score > or =3, pT stage T4, pN stage > or =N1, pM stage M1, or increased blood loss. Multivariate analysis demonstrated that OC (odds ratio (OR), 2.62; 95% confidence interval (CI), 1.34-5.13; P = 0.005), and rectal cancer (OR, 2.12; 95% CI, 1.1-4.1; P = 0.025) were independent risk factors for postoperative SBO after colectomy for colorectal cancer. Regarding the causes of SBO, paralytic obstruction was more frequent in the LAC group, and adhesive obstruction was more frequent in the OC group. CONCLUSIONS Early postoperative SBO cases are more likely to occur with OC and rectal cancer. LAC is an effective surgical procedure from the perspective of reducing the incidence of early postoperative SBO after colectomy for colorectal cancer.
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Affiliation(s)
- Jun Nakajima
- Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, 020-8505, Japan.
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Giday SA, Kantsevoy SV, Kalloo AN. Principle and history of Natural Orifice Translumenal Endoscopic Surgery (NOTES). MINIM INVASIV THER 2009; 15:373-7. [PMID: 17190662 DOI: 10.1080/13645700601038010] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The field of gastrointestinal endoscopy has been witnessing major advances over the last five decades. Developing from flexible endoscopy to endoscopic retrograde cholangiopancreatography (ERCP) in the 1950's and 70's to endoscopic ultrasound in the 80's, endoscopic technology has been transformed from serving purely diagnostic purposes to therapeutic applications. One recent major advance is the notion of using the flexible endoscope, taking it beyond the gastrointestinal lumen into what lies beyond the confines of the gastrointestinal tract. Natural orifice translumenal surgery offers the exciting potential to be safer, less invasive and possibly more cost-effective than the traditional open surgical or laparoscopic approach. The history and principles of natural orifice translumenal endoscopic surgery (NOTES), along with future implications, are outlined in this article.
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Affiliation(s)
- Samuel A Giday
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, MD, USA
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Lang RA, Weisgerber C, Grüntzig PM, Weis C, Odermatt EK, Kirschner MH. Polyvinyl Alcohol Gel Prevents Adhesion Re-Formation After Adhesiolysis in a Rabbit Model. J Surg Res 2009; 153:12-6. [DOI: 10.1016/j.jss.2008.04.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2007] [Revised: 03/09/2008] [Accepted: 04/10/2008] [Indexed: 11/16/2022]
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Dowson HM, Bong JJ, Lovell DP, Worthington TR, Karanjia ND, Rockall TA. Reduced adhesion formation following laparoscopic versus open colorectal surgery. Br J Surg 2008; 95:909-14. [PMID: 18509861 DOI: 10.1002/bjs.6211] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Adhesion formation is common after abdominal surgery. This study aimed to compare the extent of adhesion formation following laparoscopic and open colorectal surgery. METHODS An observational study was undertaken to identify adhesions in patients undergoing laparoscopy after previous laparoscopic or open colectomy. Adhesions were scored according to a system validated for interobserver (median kappa = 0.80) and intraobserver (kappa = 0.82) agreement. The primary endpoint was the overall adhesion score (0-10); a secondary endpoint was the adhesion score at the main incision site (0-6). RESULTS Forty-six patients were recruited (13 laparoscopic and 33 open colectomy). In most patients (n = 29), laparoscopy was performed for tumour staging before liver resection. The median (interquartile range) overall adhesion score was 7 (5-8) in the open group and 0 (0-3) in the laparoscopic group (P < 0.001). A similar difference was found for the main incision score: 6 (4-6) versus 0 (0-0) (P < 0.001). CONCLUSION There may be a reduction in adhesion formation following laparoscopic compared with open colectomy, although the small sample size limits this conclusion.
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Affiliation(s)
- H M Dowson
- Minimal Access Therapy Training Unit, University of Surrey, Guildford, UK.
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DeWilde RL, Trew G. Postoperative abdominal adhesions and their prevention in gynaecological surgery. Expert consensus position. ACTA ACUST UNITED AC 2007. [DOI: 10.1007/s10397-007-0338-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Peters AAW, Van den Tillaart SAHM. The difficult patient in gastroenterology: chronic pelvic pain, adhesions, and sub occlusive episodes. Best Pract Res Clin Gastroenterol 2007; 21:445-63. [PMID: 17544110 DOI: 10.1016/j.bpg.2007.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Chronic pelvic pain (CPP) with or without adhesions and symptoms of intestinal occlusion is a complex but relatively common complaint. The etiology and pathophysiology of CPP and adhesions are unclear, as is their possible relation. However, it is evident that continuous abdominal pain leads to evident suffering and disability. Unfortunately, there is little proof or evidence of success for many of the currently used diagnostic and therapeutic interventions. Laparoscopy is neither the ultimate evaluation nor the panacea for CPP or intra abdominal adhesions. An integral approach to CPP has shown beneficial results. In this multidisciplinary approach dealing with the pain is far more important than finding an organic cause and cure for the pain. Equal and simultaneous attention is paid to psychosocial, sexual and somatic aspects. The treatment of adhesions depends on the extent of symptoms and complaints. Because of the questionable relation between adhesions and pain, and the probability of reformation and de novo adhesion formation after surgery, adhesiolysis should be avoided. Even for patients with signs and symptoms of small bowel obstruction a conservative treatment is often justified. These patients require careful evaluation and management. Frequent reassessment is important to rule out impending strangulation, complete obstruction or perforation. Water soluble contrast can be useful to justify prolongation of conservative treatment and by that postpone unnecessary surgery. Most adhesive small bowel obstructions resolve following conservative treatment. The unsolved questions about etiology, diagnosis, treatment and prevention, and the great individual and community burden of CPP and adhesions clearly show that further research is needed.
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Affiliation(s)
- A A W Peters
- Department of Gynaecology, Leiden University Medical Centre, K-6-P, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
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Nappi C, Di Spiezio Sardo A, Greco E, Guida M, Bettocchi S, Bifulco G. Prevention of adhesions in gynaecological endoscopy. Hum Reprod Update 2007; 13:379-94. [PMID: 17452399 DOI: 10.1093/humupd/dml061] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Adhesions resulting from gynaecological endoscopic procedures are a major clinical, social and economic concern, as they may result in pelvic pain, infertility, bowel obstruction and additional surgery to resolve such adhesion-related complications. Although the minimally invasive endoscopic approach has been shown to be less adhesiogenic than traditional surgery, at least with regard to selected procedures, it does not totally eliminate the problem. Consequently, many attempts have been made to further reduce adhesion formation and reformation following endoscopic procedures, and a wide variety of strategies, including surgical techniques, pharmacological agents and mechanical barriers have been advocated to address this issue. The present review clearly indicates that there is no single modality proven to be unequivocally effective in preventing post-operative adhesion formation either for laparoscopic or for hysteroscopic surgery. Furthermore, the available adhesion-reducing substances are rather expensive. Since excellent surgical technique alone seems insufficient, further research is needed on an adjunctive therapy for the prevention and/or reduction of adhesion formation following gynaecological endoscopic procedures.
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Affiliation(s)
- C Nappi
- Department of Gynaecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples 'Federico II', Via Pansini 5, Naples, Italy
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Abstract
BACKGROUND Intra-abdominal adhesions constitute between 49% and 74% of the causes of small bowel obstruction. Traditionally, laparotomy and open adhesiolysis have been the treatment for patients who have failed conservative measures or when clinical and physiologic derangements suggest toxemia and/or ischemia. With the increased popularity of laparoscopy, recent promising reports indicate the feasibility and potential superiority of the minimally invasive approach to the adhesion-encased abdomen. METHODS The purpose of this study was to assess the outcome of laparoscopic adhesiolysis and to provide technical tips that help in the success of this technique. RESULTS The most important predictive factor of adhesion formation is a history of previous abdominal surgery ranging from 67%-93% in the literature. Conversely, 31% of scars from previous surgery have been free of adhesions, whereas up to 10% of patients without any prior surgical scars will have spontaneous adhesions of the bowel or omentum. Most intestinal obstructions follow open lower abdominopelvic surgeries such as colectomy, appendectomy, and hysterectomy. The most common complications associated with adhesions are small bowel obstruction (SBO) and chronic pain syndrome. The treatment of uncomplicated SBO is generally conservative, especially with incomplete obstruction and the absence of systemic toxemia, ischemia, or strangulation. When conservative treatment fails, surgical options include conventional open or minimally invasive approaches; the latter have become increasing more popular for lysis of adhesions and the treatment of SBO. Generally, 63% of the length of a laparotomy incision is involved in adhesion formation to the abdominal wall. Furthermore, the incidence of ventral hernia after a laparotomy ranges between 11% and 20% versus the 0.02%-2.4% incidence of port site herniation. Additional benefits of the minimally invasive approaches include a decreased incidence of wound infection and postoperative pneumonia and a more rapid return of bowel function resulting in a shorter hospital stay. In long-term follow up, the success rate of laparoscopic lysis of adhesions remains between 46% and 87%. Operative times for laparoscopy range from 58 to 108 minutes; conversion rates range from 6.7% to 43%; and the incidence of intraoperative enterotomy ranges from 3% to 17.6%. The length of hospitalization is 4-6 days in most series. CONCLUSIONS Laparoscopic lysis of adhesions seems to be safe in the hands of well-trained laparoscopic surgeons. This technique should be mastered by the advanced laparoscopic surgeon not only for its usefulness in the pathologies discussed here but also for adhesions commonly encountered during other laparoscopic procedures.
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Affiliation(s)
- Samuel Szomstein
- Bariatric Institute, Section of Minimally Invasive Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, Florida 33331, USA.
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van der Wal JBC, Halm JA, Jeekel J. Chronic abdominal pain: the role of adhesions and benefit of laparoscopic adhesiolysis. ACTA ACUST UNITED AC 2006. [DOI: 10.1007/s10397-006-0232-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Menzies D, Parker MC. Formation and regrowth of intra-abdominal adhesions after adhesiolysis: the paradox of surgical adhesion-reduction strategies. Dig Surg 2005; 21:458; author reply 459. [PMID: 15665543 DOI: 10.1159/000083475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Abstract
PURPOSE OF REVIEW The purpose of this review was to evaluate the indications, safety, and efficacy of laparoscopic adhesiolysis and its prevention in patients with chronic abdominal pain. RECENT FINDINGS The safety of laparoscopic adhesiolysis can be improved by using an optic trocar for laparoscopy, by using an ultrasonic technique for adhesiolysis, and by taking care with regard to risk factors. Although many studies have reported pain reduction after laparoscopic adhesiolysis, a recent randomized study showed no more pain relief than with diagnostic laparoscopy alone. The regrowth of adhesions after adhesiolysis is less after the laparoscopic technique compared with open surgery. Liquid products can prevent the formation of adhesions, but their clinical efficacy has not yet been proved in randomized studies in humans. SUMMARY Older patients with a greater number of previous abdominal operations are more prone to complications in laparoscopic surgery. The introduction of a Veress needle into the ninth intercostal space, the use of an optic trocar and ultrasonic dissection can reduce the incidence of iatrogenic bowel perforations. For chronic pain, diagnostic laparoscopy is encouraged, but laparoscopic adhesiolysis is no longer recommended; its benefit being no greater than that of diagnostic laparoscopy alone.
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Affiliation(s)
- Dingeman J Swank
- Department of General Surgery, Groene Hart Hospital, Gouda, the Netherlands.
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Gutt CN, Oniu T, Schemmer P, Mehrabi A, Büchler MW. Fewer adhesions induced by laparoscopic surgery? Surg Endosc 2004; 18:898-906. [PMID: 15108105 DOI: 10.1007/s00464-003-9233-3] [Citation(s) in RCA: 212] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2003] [Accepted: 11/21/2003] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic surgery has potential theoretical advantages over open surgery in reducing the rate of adhesion formation, but very few comparative studies are available to prove this. METHODS A literature search was performed within Medline and Cochrane databases using the key words: adhesion*, adhesiolysis, laparoscop*, laparotomy, open surgery. Further articles were identified from the reference lists of retrieved literature. Both clinical and experimental studies comparing laparoscopy and laparotomy with regard to adhesion formation were retained. In each article, the rates of adhesion formation were identified or deduced for the operative site, access wound site, and distant sites. RESULTS Fifteen studies from 1987 to 2001 were identified. Most studies assessed the operative site. Thus, three clinical studies and six experimental ones found fewer adhesions following laparoscopy than laparotomy, while other five experimental studies found similar adhesion rates for the two surgical methods. There were fewer adhesions to trocar wounds than to the laparotomy wounds in seven studies and equal rates of adhesion in one study. The problem of distant adhesions is poorly represented in literature; three studies favored laparoscopy as being followed by fewer adhesions. Because of the important differences between studies with regard to the design, end points, and statistical calculations, a metaanalysis could not be achieved. The conclusion is based on the prevalence of evidence. CONCLUSIONS All clinical studies and most of the experimental studies found a reduction of adhesion formation after laparoscopic surgery compared to open surgery.
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Affiliation(s)
- C N Gutt
- Department of General, Visceral- and Trauma Surgery, Ruprecht Karls-University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany,
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