Twelve-year outcomes of laparoscopic adhesiolysis in patients with chronic abdominal pain: A randomized clinical trial

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• 作者：Marijke J. Molegraaf ; MD^a ; ^b ; ^{mjmolegraaf@gmail.com} ; Bart Torensma^c ; Christopher P. Lange ; PhD ; MD^a ; Johan F. Lange ; PhD ; MD^b ; Johan Jeekel ; PhD ; MD^d ; Dingeman J. Swank ; PhD ; MD^a
• 刊名：Surgery
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：161
• 期：2
• 页码：415-421
• 全文大小：448 K
• 卷排序：161

文摘

Laparoscopic adhesiolysis as a therapy for chronic pain is still controversial, and long-term effects are not known; therefore, our aim was to evaluate long-term effects of laparoscopic adhesiolysis for the treatment of chronic abdominal pain believed to be related to intraperitoneal adhesions.MethodsA total of 100 patients with abdominal pain attributed to adhesions were randomized to laparoscopic adhesiolysis or a placebo group with laparoscopy alone. Pain relief was assessed after 12-year follow-up.ResultsA total of 73% of patients fulfilled the long-term follow-up. Compared to the placebo group (n = 31), patients in the adhesiolysis group (n = 42) were significantly less often pain-free (8 vs 13, P = .033, relative risk [RR] = 1.3) and to have a greater intake of analgesics (26 vs 16, P = .379, RR = 1.2, 95% confidence interval 0.8–1.8). Moreover, the adhesiolysis group sought medical consultations more frequently (14 vs 6, P = .186, RR = 1.33, 95% confidence interval 0.9–1.9), and had an increased rate of additional operation (8 vs 1, P = .042, RR = 1.67, 95% confidence interval 1.208–2.318). Both groups had improved pain and quality-of-life scores.ConclusionThis is the first, long-term, placebo-controlled trial regarding the use of laparoscopic adhesiolysis for treating chronic abdominal pain. Laparoscopic adhesiolysis was less beneficial than laparoscopy alone in the long term. Secondly, there appeared to be a powerful, long-lasting placebo effect of laparoscopy. Because adhesiolysis is associated with an increased risk of operative complications, avoiding this treatment may result in less morbidity and health care costs.