Benefit of Laparoscopic Adhesiolysis in Patients With Chronische Abdominal Pain
Benefit of Laparoscopic Adhesiolysis in Patients With Chronische Abdominal Pain
Laparoscopic adhesiolysis as a therapy for chronic pain is still controversial and long term
 effects are not known. The objective was to to evaluate long term effects of laparoscopic
 adhesiolysis for treating chronic abdominal pain.

 Therefore one hundred patients with abdominal pain attributed to adhesions were randomized to
 laparoscopic adhesiolysis or a placebo group with laparoscopy alone. Pain relief was assessed
 after 3, 6 and 12 months and 12-year follow-up.
This multi-center randomized controlled trial, included patients with chronic abdominal pain
 likely to be caused by adhesions from previous abdominal surgery. Chronic abdominal pain was
 defined as continues or intermittent abdominal pain of at least six months' duration. After
 excluding other pathology (see exclusion criteria) included patients underwent a diagnostic
 laparoscopy to confirm the adhesions and to exclude serious morbidity not visible with other
 diagnostics. If during laparoscopy adhesions were the only pathology present, patients were
 randomly assigned either to laparoscopic adhesiolysis or no treatment. For the randomization
 and surgical procedures the investigators refer to the original article. Patients were
 unaware of their treatment assignment and the outcome assessment was blinded. Abdominal pain
 and quality of life (QOL) were assessed pre-operatively and at 3, 6 and 12 months of
 follow-using a visual analog scale (VAS), verbal rating pain change score (VRCS) and the
 short form 36 (SF-36). After twelve months randomization was disclosed and placebo group
 patients with persisting abdominal pain could request laparoscopic adhesiolysis. After twelve
 year follow-up pain, QOL, medical history and analgesic intake were analyzed to assess the
 long term effects of laparoscopic adhesiolysis.
Inclusion Criteria:

 -  Patients aged 18 years and above with chronic abdominal pain that was likely to be
 caused by adhesions due to previous abdominal surgery were recruited. Before
 attributing abdominal pain to the existence of adhesions all patients had an
 extensional diagnostic work-up to exclude other pathology.

 Exclusion Criteria:

 -  Current treatment by psychologist or psychiatrist

 -  Use of laxatives, sedatives, morphine, antipsychotics, antidepressants, or drugs that
 stimulate the central nervous system

 -  Abnormal outcome of standardized non-invasive diagnostics:

 -  Biochemical investigation

 -  Lactose tolerance tests or H2 respiration test

 -  Feces analysis of worms and worm eggs

 -  Ultrasound or CT scan of the abdomen

 -  Radiographic studies of small and large bowel (or colonoscopy)