The efficacy of adhesiolysis on chronic abdominal pain: a systematic review

Abdominal adhesions are a frequent reason for chronic abdominal pain. The purpose of this systematic review was to investigate the evidence of performing laparoscopic adhesiolysis as a treatment for patients with chronic abdominal pain. Medline, Embase, and The Cochrane Central Register of Controlled Trials were searched for trials performing lysis of adhesions on patients suffering from chronic abdominal pain. Clinical studies on patients being treated for chronic abdominal pain with surgical adhesiolysis were included. The main outcome of the study was the postoperative assessment of symptoms. The Newcastle-Ottawa scale was used for bias assessment of non-randomized studies while the Jadad score was used for the randomized controlled trials. A total of 25 studies were identified evaluating the efficacy of adhesiolysis in 1281 patients suffering from chronic abdominal pain. A total of 22 trials were identified as case-series and included no control group. Three studies were identified as randomized controlled trials (RCT). A benefit of the intervention varied from 16 to 88 % in the non-randomized studies, with the majority reporting pain relief in more than 50 % of their patients. However, analysis indicated a high risk of bias in most of the studies. The RCTs also showed variance, with one study showing benefit, one study showing benefit only in a subgroup in which the patients had dense and vascularized adhesions, and one study showed no difference between the intervention and control group. The identified studies showed promising but preliminary results of laparoscopic adhesiolysis as a treatment of chronic abdominal pain. The evidence for laparoscopic adhesiolysis is not sufficient to make definitive conclusions.