The efficacy of adhesiolysis on chronic abdominal pain: a systematic review

Gerner-Rasmussen, Jonas; Burcharth, Jakob; Gögenur, Ismail

doi:10.1007/s00423-015-1316-9

Cited by 21 publications

(9 citation statements)

References 37 publications

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“…When grouping our patients according to prior or non-prior abdominal surgery, we measured a higher pain level in patients without pre-existent surgery (Fig. 5 A), which may be due to the fact, that in pre-operated patients with a likelihood for adhesions in 40–63% of gynecological or obstetric patients, [ 37 ] pain relief by adhesiolysis may have been beneficial per se [ 38 , 39 ]. Nonetheless, the use of WHCD leads to a significant reduction of pain in the patient group facing higher pain levels.…”

Section: Discussionmentioning

confidence: 99%

Warm and humidified insufflation gas during gynecologic laparoscopic surgery reduces postoperative pain in predisposed patients—a randomized, controlled multi-arm trial

et al. 2021

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Background Postoperative pain remains a common problem in gynecologic laparoscopy, especially in head zone-related regions, triggered by intra-abdominal pressure during capnoperitoneum. Humidified and prewarmed insufflation gas may ameliorate pain and be beneficial. Methods This prospective randomized controlled parallel group multi-arm single-center study investigated the effects of temperature and humidity of insufflation gas on postoperative pain during gynecologic laparoscopy with a duration ≥ 60 min. Female participants (18—70 years) were blinded and randomly assigned—computer generated—to either insufflation with dry cold CO2 with forced air warming blanket (“AIR”), humidified warm gas without forced air warming blanket (“HUMI”), or humidified warm gas with forced air warming blanket (“HUMI +”). We hypothesized that using humidified warm gas resulted in lower pain scores and less analgesic consumption. The primary endpoint postoperative pain was assessed for different pain localizations every 12 h during 7 days after surgery. Secondary endpoints were demand for painkillers and epidural anesthetics, length of stay in recovery room, and hospital stay. (Registration: ClinicalTrials.gov NCT02781194—completed). Results 150 participants were randomized. Compared to group “AIR” (n = 48), there was significantly less pain in group “HUMI +” (n = 48) in the recovery room (− 1.068; 95% CI − 2.08 to − 0.061), as well as significantly less ibuprofen use at day two (− 0.5871 g ± 0.258; p-value = 0.0471). Other variables did not change significantly. Stratification for presence of endometriosis or non-previous abdominal surgery in patient history revealed significantly less pain in both groups “HUMI” (n = 50) and “HUMI +” versus group “AIR.” Related side effects were not noted. Conclusion In the overall population, the use of warm, humidified insufflation gas did not yield clinically relevant effects; however, in predisposed patients with endometriosis and who could otherwise expect high pain levels, warm and humidified gas may be beneficial.

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Section: Discussionmentioning

confidence: 99%

Warm and humidified insufflation gas during gynecologic laparoscopic surgery reduces postoperative pain in predisposed patients—a randomized, controlled multi-arm trial

et al. 2021

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“…However, a recent literature review does not convincingly support that adhesiolysis is enough to improve abdominal and/or pelvic pain. 30 Based on many controversial and inconclusive data, we can only deduce that there is a complexity not yet disclosed on the role of peritoneal adhesion in the genesis of CPP.…”

Section: Cpp Originating In Peritoneal Adhesionsmentioning

confidence: 99%

The Potential of Cesarean Section as a Causative Factor of Chronic Pelvic Pain

Nogueira

Silva

Neto

2016

Rev Bras Ginecol Obstet

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“…However, the incidence of adhesions varies widely in the literature (45%–100%), and causal relationships to abdominal pain have been difficult to prove. No non‐invasive tests are available to diagnose abdominal adhesions, but most are identified during exploratory surgery 27,28 . Laparoscopic adhesiolysis has been proposed as a treatment for PAP 28 .…”

Section: Pap Linked To a Digestive Disordermentioning

confidence: 99%

“…Laparoscopic adhesiolysis has been proposed as a treatment for PAP 28 . A systemic review of 25 studies found a positive outcome of adhesiolysis on pain relief, but because the studies lacked controls, these results are hardly discussed 27 . However, the only randomised study comparing adhesiolysis to a sham procedure in patients with chronic abdominal pain demonstrated no beneficial effect of adhesiolysis after 1‐year follow‐up, 71 and after 12 years of follow‐up, patients with adhesiolysis had more pain, more surgery and more consultations 29 .…”

Section: Pap Linked To a Digestive Disordermentioning

confidence: 99%

“…No non-invasive tests are available to diagnose abdominal adhesions, but most are identified during exploratory surgery. 27,28 Laparoscopic adhesiolysis has been proposed as a treatment for PAP. 28 A systemic review of 25 studies found a positive outcome of adhesiolysis on pain relief, but because the studies lacked controls, these results are hardly discussed.…”

Section: Postoperative Adhesionsmentioning

confidence: 99%

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Review article: diagnostic and therapeutic approach to persistent abdominal pain beyond irritable bowel syndrome

Coffin

Duboc

2022

Aliment Pharmacol Ther

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Summary Background Persistent abdominal pain (PAP) poses substantial challenges to patients, physicians and healthcare systems. The possible aetiologies of PAP vary widely across organ systems, which leads to extensive and repetitive diagnostic testing that often fails to provide satisfactory answers. As a result, widely recognised functional disorders of the gut–brain interaction, such as irritable bowel syndrome and functional dyspepsia, are often diagnosed in patients with PAP. However, there are a number of less well‐known differential diagnoses that deserve consideration. Aim To provide a comprehensive update on causes of PAP that are relatively rare in occurrence. Methods A literature review on the diagnosis and management of some less well‐known causes of PAP. Results Specific algorithms for the diagnostic work‐up of PAP do not exist. Instead, appropriate investigations tailored to patient medical history and physical examination findings should be made on a case‐by‐case basis. After a definitive diagnosis has been reached, some causes of PAP can be effectively treated using established approaches. Other causes are more complex and may benefit from a multidisciplinary approach involving gastroenterologists, pain specialists, psychologists and physiotherapists. This list is inclusive but not exhaustive of all the rare or less well‐known diseases potentially associated with PAP. Conclusions Persistent abdominal pain (PAP) is a challenging condition to diagnose and treat. Many patients undergo repeated diagnostic testing and treatment, including surgery, without achieving symptom relief. Increasing physician awareness of the various causes of PAP, especially of rare diseases that are less well known, may improve patient outcomes.

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The efficacy of adhesiolysis on chronic abdominal pain: a systematic review

Abstract: The identified studies showed promising but preliminary results of laparoscopic adhesiolysis as a treatment of chronic abdominal pain. The evidence for laparoscopic adhesiolysis is not sufficient to make definitive conclusions.

Cited by 21 publications

References 37 publications

Warm and humidified insufflation gas during gynecologic laparoscopic surgery reduces postoperative pain in predisposed patients—a randomized, controlled multi-arm trial

Warm and humidified insufflation gas during gynecologic laparoscopic surgery reduces postoperative pain in predisposed patients—a randomized, controlled multi-arm trial

The Potential of Cesarean Section as a Causative Factor of Chronic Pelvic Pain

Review article: diagnostic and therapeutic approach to persistent abdominal pain beyond irritable bowel syndrome

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