Clinical Study of Laparoscopic Surgery in the Patients with Intraabdominal Adhesion

Jun-ich Tanaka, Hideaki Andoh, Masanao Ito, Yoshihiro Asanuma, Kenji Koyama

Department of Surgery, Akita University School of Medicine

We performed laparoscopic surgery on 38 patients with intraabdominal adhesions without intestinal obstruction due to adhesion. We investigated the location and degree of adhesion, the necessity of adhesiolysis and complications according to the past history of abdominal surgery or intra-abdominal inflammation. Twenty-four out of 38 patients (63%) underwent laparoscopic adhesiolysis to complete the laparoscopic surgery. Patients with previous surgery of upper abdomen needed adhesiolysis due to moderate to severe adhesion of intestines, meanwhile most patients with previous lower abdominal surgery underwent no adhesiolysis due to location of adhesion. Patients with intraabdominal inflammation had moderate to severe adhesion and needed laparoscopic adhesiolysis. Operations on two patients with cholecystocholedocholithiasis were converted to open laparotomy because of marked inflammation around the cystic duct (5.3%). The duodenal injury was observed in two patients with choleithiasis after distal gastrectomy with Billroth-Il anastomosis. They were repaired under open surgery or laparoscopic surgery. Adhesion between the intestine and the peritoneum in the anterior abdominal wall can be easily dissected under laparoscopy, but laparoscopic adhesiolysis among the intestines themselves should be avoided because of the high risk of intestinal injury.

Key words
laparoscopic surgery, intraabdominal adhesion, laparoscopic adhesiolysis

Reprint requests
Jun-ichi Tanaka Department of Surgery, Akita University School of Medicine
1-1-1 Hondo, Akita, 010, JAPAN

Accepted
April 23, 1997

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