Two Cases of Laparoscopic Adhesiolysis for Chronic Abdominal Pain without Intestinal Obstruction after Total Gastrectomy

Abstract

Chronic abdominal pain remains a challenge to all known diagnostic and treatment methods with patients undergoing numerous diagnostic work-ups including surgery. However, the surgical treatment of patients with chronic intractable abdominal pain is controversial. There has been no discussion of the indications for adhesiolysis in cases of obstruction or strangulation of the bowel, and adhesiolysis by laparotomy has never gained acceptance as a treatment modality for chronic abdominal pain. One of the reasons for this lack of acceptance is the high complication rate during and after adhesiolysis. Laparoscopic surgery has been accepted as a technique for diagnostic and therapeutic procedures in general surgery. Laparoscopy allows surgeons to see and treat many abdominal changes that could not otherwise be diagnosed. Here we report two cases of successful symptomatic improvement through laparoscopic adhesiolysis for chronic abdominal pain without intestinal obstruction after total gastrectomy.

Keywords: Abdominal pain; Adhesion; Gastrectomy; Laparoscopy.

Fig. 1

(A) A preoperative abdominopelvic computed tomography scan and (B, C) simple abdominal x-rays showed no definite evidence of intestinal obstruction, except for mild paralytic ileus.

Fig. 2

(A) Multiple dense adhesions in the small bowel mesentery were found intraoperatively and (B) were released with endoscopic scissorsor ultrasonic shears.

Fig. 3

(A) Abdominopelvic computed tomography and (B, C) upper gastrointestinal studies showed no stricture, intestinal obstruction, or passage disturbance.