Laparoscopic adhesiolysis in treatment of post appendectomy pain in right iliac fossa- an evaluation

Background: Post-operative complications following appendectomy are relatively not uncommon and pain during this period is sometimes seen. Persistent or reappearance of similar pain causes the loss of patient’s confidence on the procedure itself as well as despair for surgeons.Methods: The study was conducted at our institution to determine the cause of post appendectomy right iliac fossa pain and to evaluate the role of laparosopic adhesiolysis as a therapeutic tool. 35 patients with post appendectomy right iliac fossa pain were included in the study and outcome of post-operative peri-caecal adhesions (if found) treatment with laparoscopic adhesiolysis was assessed.Results: 80% of the 35 patients were in the age group of 18-38 years. 37.14% (13 patients) were symptomatic within 1 year of appendectomy. Pain due to post-operative adhesion was found in 20% (7) of the patients. With laparoscopic adhesiolysis, the diagnostic accuracy rate was 78.57% and therapeutic relief in pain was 85.72% of the patients in our study.Conclusions: Patients presenting recurrent pain in right iliac fossa, after appendectomy should not be overlooked. Patients with recurrent right iliac fossa pain following appendectomy may benefit from laparoscopy, both as a diagnostic tool and with the added advantage of treating the patients simultaneously in the form of laparoscopic adhesiolysis. Adhesiolysis has offered pain free life as long as our follow up is concerned.

Adhesion reformation and the limited translational value of experiments with adhesion barriers: A systematic review and meta-analysis of animal models

Today, 40–66% of elective procedures in general surgery are reoperations. During reoperations, the need for adhesiolysis results in increased operative time and a more complicated convalescence. In pre-clinical evaluation, adhesion barriers are tested for their efficacy in preventing ‘de novo’ adhesion formation, However, it is unknown to which extent barriers are tested for prevention of adhesion reformation. The aim of this systematic review and meta-analysis is to assess the efficacy of commercially available adhesion barriers and laparoscopic adhesiolysis in preventing adhesion reformation in animal models. Pubmed and EMBASE were searched for studies which assessed peritoneal adhesion reformation after a standardized peritoneal injury (in the absence of an intra-peritoneal mesh), and reported the incidence of adhesions, or an adhesion score as outcome. Ninety-three studies were included. No study met the criteria for low risk of bias. None of the commercially available adhesion barriers significantly reduced the incidence of adhesion reformation. Three commercially available adhesion barriers reduced the adhesion score of reformed adhesions, namely Seprafilm (SMD 1.38[95% CI]; p < 0.01), PEG (SMD 2.08[95% CI]; p < 0.01) and Icodextrin (SMD 1.85[95% CI]; p < 0.01). There was no difference between laparoscopic or open adhesiolysis with regard to the incidence of adhesion reformation (RR 1.14[95% CI]; p ≥ 0.05) or the adhesion score (SMD 0.92[95% CI]; p ≥ 0.05). Neither currently commercially available adhesion barriers, nor laparoscopic adhesiolysis without using an adhesion barrier, reduces the incidence of adhesion reformation in animal models. The methodological quality of animal studies is poor.