Selective laparoscopic adhesiolysis in the management of acute and chronic recurrent adhesive bowel obstruction

BACKGROUND: Laparoscopic adhesiolysis became popular in the last decade for the management of postoperative adhesive small bowel obstruction. This paper investigates the feasibility, effectiveness and safety of laparoscopy in this field; the details of a selective adhesolysis were discussed as well. METHODS: The patients who underwent laparoscopic management of acute or chronic recurrent adhesive bowel obstruction were included into the study. The patients were managed according to a specific algorithm. If the conservative management has failed, selective laparoscopic adhesiolysis to the transition zone of distended /collapsed bowel was performed. Patients, who were suffering from chronic recurrent obstruction attacks and those who tolerated oral intake, underwent preoperative enteroclysis studies and selective adhesiolysis was performed according to imaging findings. Computerized tomography was performed in all cases to exclude other diagnoses. RESULTS: Thirty-one patients (22 female, 9 male) underwent laparoscopic adhesiolysis from January 1998 to June 2007. The mean age was 48 (range: 20-80). Enteroclysis - guided laparoscopic adhesiolysis was performed in nineteen patients. Twelve patients underwent laparoscopic adhesiolysis for acute obstruction. Enteroclysis was able to demonstrate the pathological adhesion or band in all of the patents who underwent this imaging technique. Conversion and complication rates were 9.6%. The entire patients tolerated well oral intake postoperatively except one who had underwent enteroclysis-guided adhesiolysis; the patient presented with transient subileus on postoperative day 34 and responded well to conservative management. Mean hospital stay was 4.1 days (range: 2-7). The patients are free of symptoms on their follow-up.
CONCLUSION: Laparoscopy is feasible, safe and effective in postoperative adhesive disease. Laparoscopic adhesiolysis should be performed as selective as possible in acute and chronic cases. Enteroclysis is a helpful imaging modality for performing selective laparoscopic adhesiolysis in chronic obstruction.

Akut ve kronik tekrarlayan, ameliyat sonrasý yapýþýklýklara baðlý baðýrsak týkanýklýklarýn tedavisinde selektif laparoskopik adezyolizis

AMAÇ: Laparoskopik adezyolizis adezyonlara baðlý ameliyat sonrasý ince baðýrsak týkanýklýklarýnýn tedavisinde son dekadda popülarite kazanmýþtýr. Bu çalýþmada, laparoskopinin bu alanda uygulanabilirliði, etkinliði ve güvenliðini araþtýrýldý ve selektif adezyolizisin ayrýntýlarý tartýþýldý. GEREÇ-YÖNTEM: Bu çalýþmaya yapýþýklýklara baðlý, akut veya kronik tekrarlayan ince baðýrsak týkanýklýðý nedeniyle laparoskopik tedavi görmüþ hastalar dahil edildi. Hastalar belirli bir algoritmaya göre tedavi gördü. Konservatif tedavinin yetersiz kaldýðý hastalar ameliyata alýnarak sönük/þiþkin baðýrsak geçiþinin olduðu bölgeye selektif laparoskopik adezyolizis uygulandý. Kronik tekrarlayan ataklar geçiren ve konservatif tedaviye yanýt vermiþ hastalarda ameliyat öncesi enteroklizis uygulandý ve adezyolizis bu bulgular kýlavuzluðunda yapýldý. Diðer tanýlarý dýþlamak amacýyla tüm olgularda bilgisayarlý tomografi incelemesi yapýldý.
BULGULAR: Ocak 1998 - Haziran 2007 tarihleri arasýnda 31 hastaya (22 kadýn, 9 erkek) laparoskopik adezyolizis yapýldý. Ortalama yaþ 48 (aralýk 20-80) idi. Enteroklizis kýlavuzluðunda laparoskopik adezyolizis 19 hastada uygulandý. On iki hastaya akut týkanýklýk nedeniyle laparoskopik adezyolizis uygulandý. Enteroklizis, bu görüntüleme yönteminin uygulandýðý hastalarýn tümünde patolojik yapýþýklýk veya bandý göstermeyi baþardý. Komplikasyon ve açýða geçiþ oraný %9,6 olarak gerçekleþti. Hastalarýn tümünde ameliyat sonrasý dönemde oral alým tolere edildi. Enteroklizis kýlavuzluðunda laparoskopik adezyolizis uygulanmýþ bir hastada ameliyat sonrasý 34. günde konservatif tedaviye yanýt veren geçici subileus ataðý oldu. Ortalama hastanede yatýþ süresi 4,1 gün (aralýk: 2-7) olarak gerçekleþti. Hastalar takiplerinde semptomsuz seyretmektedir. SONUÇ: Ameliyat sonrasý yapýþýklýklara baðlý baðýrsak týkanýklarýnda laparoskopi uygulanabilir, güvenli ve etkin bir yöntemdir. Laparoskopi akut veya kronik olgularda olabildiðince selektif uygulanmalýdýr. Enteroklizis, kronik týkanýklýklarda selektif laparoskopi uygulanmasýna olanak veren yararlý bir görüntüleme yöntemidir.