Page 156 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Chapter 9
preferred to prevent strong adhesion formation. We also concluded that biological meshes are not necessarily superior to synthetic meshes.
Adhesions and chronic abdominal pain
The role of abdominal adhesions as cause of chronic abdominal pain is still widely under debate. Traction of adhesions on the peritoneum and viscera, nerve fibers in adhesions itself or changes in the nervous system are all mechanisms which are suggested to contribute to chronic abdominal pain caused by adhesions when other organic and functional diseases are excluded [29]. Despite these different hypotheses it has been shown that laparoscopic adhesiolysis was of equal benefit to patients as was diagnostic laparoscopy alone [30]. Recently these results were confirmed in a prospective cohort study demonstrating that adhesiolysis in itself does not affect functional status and quality of life six months after surgery [31].
Provided that abdominal adhesions can cause chronic abdominal pain one might expect more abdominal complaints after appendectomy for complicated appendicitis. In this respect in Chapter 7 the results of a study were presented with long-term follow-up of seven years to investigate whether appendectomy for complicated appendicitis would result in more abdominal complaints than operation for uncomplicated acute appendicitis. In addition the influence of operation technique (open versus laparoscopic) was studied. Demographic data, operative reports, peroperative adhesions and complications, abdominal pain and satisfaction were monitored. In total 1433 patients were invited to fill out a questionnaire with a median follow-up of 7.1 years and finally questionnaires of 526 (37%) patients were suitable for analysis. The results of this study showed that after long-term follow-up the incidence of abdominal complaints was not influenced by laparoscopic or open approach nor whether the acute appendicitis was complicated or not.
Additionally in Chapter 8 we presented the results of a study with an analogous design as described in Chapter 7 to investigate the incidence of abdominal complaints in the long-term after acute and elective surgery for diverticulitis. 208 Patients were invited to complete a questionnaire
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