World Journal of Laparoscopic Surgery

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VOLUME 3 , ISSUE 1 ( January-April, 2010 ) > List of Articles


Comparative Study of Postoperative Adhesions by Laparotomy and Laparoscopic Procedures

Rama Hegde

Citation Information : Hegde R. Comparative Study of Postoperative Adhesions by Laparotomy and Laparoscopic Procedures. World J Lap Surg 2010; 3 (1):31-36.

DOI: 10.5005/jp-journals-10007-1078

Published Online: 01-08-2012

Copyright Statement:  Copyright © 2010; The Author(s).



Abdominal operations result in random and unpredictable adhesion formation. Postoperative adhesion may contribute to recurrent episodes of small bowel obstruction, chronic pain abdomen or both. Laparotomy and laparoscopy are the modes used to treat the adhesion related complications.

Aims and objectives

(1) To study the adhesion related complications and treat the same by means of laparotomy and laparoscopic procedures. (2) To study how the risk of postoperative adhesions can be minimized.

Materials and methods

About 50 cases from March 2007 to February 2009 were studied in Government hospital, Sirsi, Karnataka, India. Patients who underwent some surgical procedures before presenting with adhesions related complications like small bowel obstruction and chronic pain abdomen were considered. Patients who required intervention were treated with surgical procedures. Patients who presented with obstructive features underwent laparotomy and who presented with chronic pain abdomen underwent laparoscopy.


All the 50 patients who were in our study had undergone some conventional surgeries in previous instance. No patient in our study had undergone laparoscopy in previous instance. Appendicectomy (40%), lower segment cesarean section (22%) were the common surgeries which resulted in adhesions. Thirty-four patients in our study presented with obstructive features, underwent laparotomy and adhesiolysis. Sixteen patients in our study underwent laparoscopy for chronic pain abdomen. Both surgeries were safe and resulted in recovery of almost all patients. We could not follow-up most of the patients after 3 months so the outcome of adhesiolysis by both procedures is not known.


(1) Conventional surgeries leads to more adhesion formation than the minimal invasive procedures. (2) Appendicectomy and pelvic surgeries are the common cause of adhesions. (3) Both laparotomy and laparoscopy can be safely used as mode of treatment of adhesion related complications. (4) Operative treatment of acute abdomen by laparoscopy can be recommended.

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  1. Laparoscopic management of acture small bowel obstruction. Aust NZJ Surg 1993;63:39-41.
  2. Plaminogen activatorinhibitors: Hormonally regulated serpins. Mol Cell Endocrinol 1990;68:1-19.
  3. Peritoneal and systemic cytokinc response to laparotomy. Br J Surg 1996;83:347-48.
  4. Long-term analysis of peritoneal plasminogen activator activity and adhesion formation after surgical trauma in the rat model. Fertile Steril 1996;66:1018-22.
  5. prevention of postoperative abdominal adhesions by a sodium hyaluronate based to resalable membranes a preoperative randomized double blind multicentce shedy. J Ann Coll Surgery 1996;183:297-306.
  6. Risk of anterior abdominal wall adhesions inpatients with umbilical hernia repair. J Am Assoc Gynecol Laparosc 1994;1,4:S4.
  7. Gynecological laparoscopy: Report on the confidential enquiry into gynecological laparoscopy. London: Royal college of obstetricians and gynecologists, 1978.
  8. The peritoneum. NewYork Springer- Veriag 1992;11-25.
  9. contribution of CT to decision making in the management of adhesive small bowel obstruction. Br J Surg 1988;85:1071-74.
  10. Adhesion related hospital readmissions after abdominal and pelvic surgery, a retrospective cohort study lancet 1999,427;653-55.
  11. The clinical significance of adhesions; Focus on intestinal obstruction. Eur J Surg 1997;S577:5-9.
  12. CT of small bowel obstruction. Am J Roentgenol 1994;162:37-41.
  13. Transvaginal ultrasonography in the diagnosis of pelvic adhesions. Hum Reprod 1997;12:2649-53.
  14. CT of the small bowel. Appl Radial 1994;11:39-44.
  15. Short-term effect of surgical trauma on rat peritoneal fibronolytic activity and its role in adhesion formation. Thromb Haemost 2000;84:876-81.
  16. The effect of interleukin–1, on adhesion formation in the rat. Am J obstet Gynecol 1991;4:141-51.
  17. Fibrinolysis in human peritoneum during operation. Surgery 1996;119:701-05.
  18. Plasminogen activators and inhibitors in peritoneal tissue. APMIS 1997;105:25-30.
  19. Depression of peritoneal fibrinolysis during operation is a local response of trauma. Surgery 1998;123:539-44.
  20. Tissue markers as predictors of postoperative adhesions. Br J Surg 1998;85:1549-54.
  21. Decreased fibrinolytic properties of mesothlial cells isolated from peritoneal lavage. Scand J Clin Lab Invent 1998;58:195-203.
  22. Expression and kinetics of fibronolytic components in plasma and peritoneum during abdominal surgery. Fibrinolytic 1998;21:61-67.
  23. Expression and kinetics of fibrinolytic components in plasma and peritoneum during abdominal surgery. Fibrinolusis Proteolysis 1998;12:61-67.
  24. Arthur F Clinically oriented anatomy (4th ed), 209-19.
  25. Clinical adis in strangulated intestinal obstruction. Am J Surg 1970;120:756-58.
  26. Risk of anterior abdominal wall adhesions increase with number and type of previous laparotomy. J Am Assoc Gynecol Laparosc 1994;1(4):S19.
  27. Comparative thrombolytic properties of tissue-type plasminogen activator (t-PA), single – chain urokinasetype plasminogen activator (u-PA) and KIK2Pu (a t-PA/u-PA chimera) in a combined arterial and venous thrombosis model in the dog. J Am Coll Cardiol 1992;19:1350-59.
  28. Effect of interleukin- 1, inflammation and surgery on the incidence of adhesion formation after abdominal irradiation in mice. Cancer Res 1988;49:169-73.
  29. Intestinal obstruction from adhesions: How big is the problem? Ann R Coll Surg Engl 1990;72:60-63.
  30. Biology and biochemistry of proteinases in tumor invasion. Physiol Rev 1993;73:161-95.
  31. Improvement of interobserver reproducibility of adhesion scoring systems. Adhesion Scoring Group. Fertil Steril 1994;62(5):984-88.
  32. Regeneration of peritoneal and visceral perito-neum. Alight microscopical study. Br J Surg 1973;60:293-99.
  33. Small Bowel obstruction in previous gynecologic surgery. South Med J 1983;76:1349-50.
  34. Function of peritoneal exudates cells after abdominal surgery. J Invest Surg 1993;6:9-23.
  35. The operative peritoneal fibrinolytic response to abdominal operation. Eur J Surg 1995;161:395-99.
  36. Human intraperitoneal fibrinolytic response to elective surgery. Br J Surg 1995;82:414-17.
  37. Decreased fibrinolytic activity of human mesthelial cells in vitro following stimulation with transforming growth factor b1 interleukin-1b, and tumour necrosis factor-alpha. In: Treutner K-H, Schumpelick V (Eds) peritoneal adhesions. Berlin: Springer 1997;146-59.
  38. Coagulation and fibrinolytic responses of human peritoneal fluid and plasma to bacterial peritonitis. Br J Surg 1996;83:1133-35.
  39. Fibrinolytic activity in the abdominal cavity of rats with faecal peritonitis. Br J Surg 1994;81:1046-49.
  40. Progress of fibrinolysis during tumour necrosis factor infusion in humans. Concomitant increase in tissue-type plasminogen activator, plasminogen activator inhibitor type-1, and fibrinogen degradation products. Blood 1990;76:2284-89.
  41. Morbidity and mortality of inadverent enterotomy during adhesiotomy. Br J Surg 2000;87:467-71.
  42. Tumour biology. Membrane proteases in focus. Nature 1994;370:14-15.
  43. Effect of experimental peritonitis and ischemia on peritoneal fibrinolytic activity. Eur J Surg 1994;160:471-77.
  44. Peritoneal fibrinolytic activity and intra-abdominal adhesions. Lancet 1990;335:1120-22.
  45. Adhesions In: Welch JP (Ed). Bowel Obstruction. Philadelphia: WB Saunders 1990:154-65.
  46. Tumour necrosis factor mediated release of plasminogen activator inhibitor–1 by human peritoneal mesothelia cells. Br J Surg 1994;81:214-16.
  47. A review of the management of small bowel obstruction. Ann R Coll Surg Engl 1999;81:320-28.
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