Long-term follow-up of pain and quality-of-life scores after laparoscopic adhesiolysis

Abstract

There is increasing evidence that laparoscopic adhesiolysis improves chronic pelvic pain. We performed a long-term review of women after laparoscopic adhesiolysis over the past 4 years. Patients were excluded from the study if they had additional pathology such as endometriosis or required additional procedures other than adhesiolysis. Umbilical insertion of Verress' needle and primary trocar was used except when the patient had had a previous midline laparotomy, in which case Palmer's point was used for entry. Adhesions were divided using Metzenbaum scissors with haemostasis using suction irrigation achieved with a Surgiflex R Wave suction irrigation system with BICAP bipolar diathermy probe (ACMI , USA). Hydroflotation with heparinised saline or 4% icodextrin was used to reduce adhesion recurrence. Patients were sent a postal questionnaire and contacted by telephone. Visual analogue scales were used to record pain scores for dysmenorrhoea (in those women who still had a uterus), dyspareunia, dyschezia and chronic daily pain. An EQ-5D questionnaire was also enclosed to assess quality of life. One hundred and forty-three procedures were identified between September 1998 and July 2002. Having excluded those with additional pathology that required treatment, 90 were eligible for the study. Seventy-six replies were obtained; seven patients had moved away. Sixty-nine replies were analysed. Fifty-one (74%) reported some improvement in their symptoms [12 (17%) pain completely gone, 26 (38%) greatly improved, 13 (19%) a little better]. Patients still had significant pain [scores out of 100 for dysmenorrhoea (45), dyspareunia (28), dyschezia (28) and daily pain (29)]. Overall, quality of life was still lower than national averages (self-rated health status mean =67.0 vs. 82.34, P< 0.05, weighted health state index =0.67 vs. 0.85, P< 0.05), except in the good responders (pain gone or greatly improved, for whom quality of life returned to normal). There was no difference in pain scores, response and quality of life between women who had had their surgery more than 24 months earlier and those who had had surgery more recently. We have found a good response to adhesiolysis, which is comparable with other studies. A good response is associated with a normal quality of life and appears to be long standing.

Cine-MRI detection of intraabdominal adhesions: correlation with intraoperative findings in 89 consecutive cases

“…According to the literature, the most frequent symptoms are acute and chronic abdominal pain and meteorism [16,30,38,39]. Several authors describe adhesions in more than 40% of the patients as the most frequent reason for chronic pain in the pelvic area [5,31]. In the current study, the most frequent symptoms were diffuse abdominal pain (42% of cases) and postprandial, partly colicky, pain (34% of cases).…”