Laparoscopic Evaluation for Post-operative Abdominal Pain

Maliheh Khosravi, MD. Imam Reza hospital.

Chronic post-operative abdominal pain especially after a heavy meal is a common problem in this setting. Approximately 20% of patients which underwent laparotomy have chronic post-prandial abdominal pain for months after operation. About 50% of them are referred to their doctors for treatment. Most of the surgeons are not interested for a second operation in this condition, and perform to do conservative treatment. This study evaluates the cause of this chronic abdominal pain with diagnostic and therapeutic laparoscopic surgery.

Method and procedures
Elective laparoscopic surgery was performed on 76 patients suffering chronic abdominal pain mostly after heavy meal. They did not have any sign and symptom of acute intestinal obstruction and the most popular complaints were: abdominal pain in 100%, nausea in 30%, vomiting in 10%. Diagnostic laparoscopy was detected positive abdominal findings in 81% of patients. At the same operation, treatment modalities (laparoscopic enterloysis) were performed.

In 81% of patients the cause of pain was intestinal adhesions do to adhesional bands. From the remaining, 10% had adhesions without any correlation to the patient’s symptoms. Adhesiolysis (sharp release with scissor) is the treatment of choice. 95% of those patients that underwent adhesiolysis became pain free for a mean average of 11 months fallow up (pre-operative average of pain episode was 4 time per week).

In a patient with post-prandial chronic abdominal pain and a history of previous laparotomy, diagnostic and therapeutic laparoscopic Adhesiolysis can be an effective method for treatment.

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