Comparative Study On Degree Of Postoperative Abdominal Adhesion Between Laparotomy And Laparoscopic Operation

Backgroud and objective: Postoperative adhesion after abdominaloperation is clinical phenomenon. Adhesion caused seriouscomplications such as intestinal obstruction, pain of abdominal cavityand pelvis cavity, and infertility. Serious abdominal adhesion leaded tobe difficult in the second operation. The degree of body damage hadbecome the investigative hot spot with the laparoscopic techniquespeading. It was the urgent question whether laparoscopic techniquecould lessen the degree of postoperative adhesion and which kinds ofmechanism was involved. The study was to choose patients as studyobjects with the history of laparoscopic operation or laparotomy. Thedegree of abdominal adhesion was evaluated between the patients withthe history of laparoscopic operation and thoses with the history oflaparotomy when the second operation was performed. All patientsunderwent laparoscopic operation. New theoretic proof was brought outso as to evaluate laParoscopic operation in the aspect of abdominaladhesion.Methods: 95 patients were chosen to perform abdominal operation withlaparoscopy in the department of surgery and gynaecology and obstetricsin the first affiliated hospital of Jinan university. All patients had the history of abdominal operation in the ten years. Patients were dividedinto two group according to operative history: group A (laparotomy) andgroup B(laparoscopic operation). There was no difference in sex, age,and history of operative time between two groups. The degree ofabdominal adhesion was studied by B type ultrasound before surgeryand was evaluated directly during the course of operation. The resultswere analyzed.Results: 51 patients had the history of laparotomy and 44 patients hadthe history of laparoscopy. All patients performed the second operationwith laparoscopy in the hospital. There was no difference in age, sex,time of operative history and operative style between two groups. Therewere 14 cases with no adhesion and 37 cases with adhesion in the Agroup while 32 cases with no adhesion and 12 cases with adhesion in theB group evaluated by B type ultrasound before operation. There were20 cases with adhesion from class 0 to classⅠand 31 cases withadhesion from classⅡto classⅣin the A group while 11 cases withadhesion from class 0 to classⅠand 33 cases with adhesion from classⅡto classⅣin the B group evaluated during the course of theoperation.There was significantly difference in the adhesion degree between twogroups evaluated by B type ultrasound or during the course of operation (P＜0.05). However, there was no difference between the results obtainedby B type ultrasound and results got in the operative exploration(P＞0.05).Conclusions: B type ultrasound was a reliable diagnosis method inclinic for abdominal adhesion. Compared with laparotomy, laparoscopicoperation could prevent or lesson postoperative abdominal adhesionobviously Then the incidence rate of postoperative complicationsdecreased. B type ultrasound had the same value as laparoscopicexploration in the aspect of evaluation of abdominal adhesion.