» Articles » PMID: 28333221

Surgical Treatment of Adhesion-related Chronic Abdominal and Pelvic Pain After Gynaecological and General Surgery: a Systematic Review and Meta-analysis

Overview
Date 2017 Mar 24
PMID 28333221
Citations 25
Authors
Affiliations
Soon will be listed here.
Abstract

Background: Chronic pain is a frequent post-operative complication, affecting ~20-40% of patients who have undergone surgery of the female genital or alimentary tract. Chronic pain is an important risk factor for diminished quality of life after surgery. Adhesions are frequently associated with chronic post-operative pain; however, surgical treatment of adhesion-related pain is controversial.

Objective And Rationale: The aim of this study was to investigate the efficacy and harms of surgical interventions for chronic post-operative pain attributable to adhesions.

Search Methods: A search was conducted using PubMed, EMBASE and CENTRAL, without restrictions pertaining to date, publication status or language. Randomized trials and cohort studies from all surgical interventions for chronic post-operative pain were considered eligible. Patients with a concomitant diagnosis that could cause chronic pain (e.g. endometriosis or inflammatory conditions) were excluded. Outcome measures were graded according to clinical relevance, with improvement of pain at long-term follow-up regarded as most clinically relevant.

Outcomes: A total of 4294 unique citations were identified, of which 13 studies met the criteria for inclusion. Two of the analysed studies were randomized trials, of which one had a low risk of bias. Only one trial, randomizing between laparoscopic adhesiolysis without an adhesion barrier and diagnostic laparoscopy, reported improvement of pain at long-term follow-up. In this trial, pain improved in 55.8% of patients after adhesiolysis and in 41.7% of patients in the control group; however, the difference was not significant (relative risk (RR) 1.34; 95% CI: 0.89-2.02). Most non-randomized studies had mid-length follow-up (6-12 months). In pooled analyses of trials and non-randomized studies, improvement of pain was reported in 72% of patients who underwent adhesiolysis (95% CI: 61-83%) at any follow-up longer than 3 months. The incidence of negative laparoscopies was 20% (95% CI: 10-30%). The overall incidence of complications following laparoscopic adhesiolysis was 4% (95% CI: 1-6%).

Wider Implications: Laparoscopic adhesiolysis reduces pain from adhesions in ~70% of patients in the initial phase after treatment. However, there is little evidence for long-term efficacy of adhesiolysis for chronic pain. Other drawbacks of laparoscopic adhesiolysis are the high rate of negative laparoscopies and the risk of bowel injury. At present, there is little evidence to support routine use of adhesiolysis in treatment for chronic pain. New research is needed to investigate whether the results of adhesiolysis can be improved with new techniques for diagnosis and prevention of adhesion reformation.

Citing Articles

An evaluation of the relationship between striae gravidarum and intra-abdominal adhesions in caesarean section.

Akdas Reis Y, Akay A, Firatligil F, Yilmaz-Ergani S, Mammadova N, Savran-Ucok B J Turk Ger Gynecol Assoc. 2025; 26(1):41-48.

PMID: 40077971 PMC: 11905183. DOI: 10.4274/jtgga.galenos.2024.2024-4-8.


Mesothelial cell responses to acute appendicitis or small bowel obstruction reactive ascites: Insights into immunoregulation of abdominal adhesion.

Hausburg M, Banton K, Cassidy C, Madayag R, Palacio C, Williams J PLoS One. 2025; 20(1):e0317056.

PMID: 39775680 PMC: 11709316. DOI: 10.1371/journal.pone.0317056.


Adhesion barriers in gynecologic surgeries and cesarean section: An Asia-Pacific expert panel consensus recommendation.

Tanigaki S, Batra A, Chan T, Kang J, Lam S, Lim T Int J Gynaecol Obstet. 2024; 168(2):436-448.

PMID: 39277817 PMC: 11726167. DOI: 10.1002/ijgo.15903.


An artificial intelligence approach for investigating multifactorial pain-related features of endometriosis.

Kiser A, Schliep K, Hernandez E, Peterson C, Yandell M, Eilbeck K PLoS One. 2024; 19(2):e0297998.

PMID: 38381710 PMC: 10881015. DOI: 10.1371/journal.pone.0297998.


Techniques for navigating postsurgical adhesions: Insights into mechanisms and future directions.

Chen J, Tang X, Wang Z, Perez A, Yao B, Huang K Bioeng Transl Med. 2023; 8(6):e10565.

PMID: 38023705 PMC: 10658569. DOI: 10.1002/btm2.10565.