Twelve-year outcomes of laparoscopic adhesiolysis in patients with chronic abdominal pain: A randomized clinical trial
Background: 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. Methods: A 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. Results: A 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. Conclusion: This 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.
|Persistent URL||dx.doi.org/10.1016/j.surg.2016.08.014, hdl.handle.net/1765/95084|
Molegraaf, M.J. (Marijke J.), Torensma, B. (Bart), Lange, C.P. (Christopher P.), Lange, J.F, Jeekel, J, & Swank, D.J. (Dingeman J.). (2017). Twelve-year outcomes of laparoscopic adhesiolysis in patients with chronic abdominal pain: A randomized clinical trial. Surgery, 161(2), 415–421. doi:10.1016/j.surg.2016.08.014