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abdominal pain
Discussion in 'All Categories' started by VANESSA NIEVES - Nov 14th, 2011 11:59 pm.
Abdominal pain for 2 months. Thought it was kidney stones. Lab work and a cystoscopy came out good. Had colonoscopy which was good. CT scan and ultrasound of abdomen and pelvis show nothing. Gyn check up was good. Had my appendix removed on 97. Had scar tissue from that removed on 02. Still in lots of pain with no answer from any of my doctors. Pain radiates from the lower right hand side(ovary) up into my ribs and has spread on the same side lower back and into ribs in the back. i also have a burning sensation with the pain
re: abdominal pain by Dr M.K. Gupta - Nov 17th, 2011 10:20 pm
Dr M.K. Gupta
Dr M.K. Gupta

Your problem may be due to adhesion developed after previous surgery. In our opinion you should get one diagnostic laparoscopy done. Laparoscopy is an effective tool for the evaluation of patients with chronic pain. Laparoscopic adhesiolysis is assigned to significant relief of chronic abdominal pain in additional than 80 % of patients. Laparoscopic adhesiolysis was also found to be more effective than microsurgical adhesiolysis for infertility. Although complications because of adhesiolysis are rare, there is understandable worry about blunt, sharp, or thermal injury to the bowel. Adhesions are frequently involved between two organs and most often involve the bowel. The possibility of injury during abdominal entry with a Veress needle or trocar exists in patients with or without a previous good reputation for laparotomy. To adequately perform laparoscopic adhesiolysis, three or four abdominal punctures are required - the infraumbilical incision for that operative laparoscope and 2 to 3 lower, lateral punctures for introduction of ancillary instruments. Successful insertion depends on adequate skin incision, the trocar working condition, proper orientation, and control over the instrument
re: abdominal pain by Dr M.K. Gupta - Nov 17th, 2011 10:23 pm
Dr M.K. Gupta
Dr M.K. Gupta

Your problem may be due to adhesion developed after previous surgery. In our opinion you should get one diagnostic laparoscopy done. Laparoscopy is an effective tool for the evaluation of patients with chronic pain. Small diameterlaparoscopy instead of open laparoscopy may be used for initial abdominal entry in patients in danger of adhesions. Through the lateral trocar, on the side of the assistant, an atraumatic grasping forceps is inserted to hold the adhesion or involved organ, stretch it, and identify the edge and avascular planes. The opposite trocar, along the side of the surgeon, is used for microscissors or the suction-irrigator probe. Dense adhesions are severed first, then thin and filmy adhesions. This approach allows for progressive exposure of the pelvic structures. Once the intestines are let go from the adjacent structures, they may be pushed cephalad. In the pelvis, adherent ovaries are let go from the pelvic sidewall, broad ligament, tubes, and uterus. Once the ovaries are lifted in the cul-de-sac and mobilized, all peritubal adhesions are removed. Any bleeding that cannot be controlled with the laser is desiccated while using bipolar or unipolar electrocoagulator to maintain a definite field.

Adhesion formation is a serious concern following pelvic surgery. Adhesion formation in the vaginal cuff and pelvic sidewall usually involves bowel and omentum. This may lead to pelvic pain, dyspareunia, small bowel obstruction, and residual ovary syndrome when salpingo-oophorectomy is not performed. Adhesions were recognized as the main reason for chronic pelvic pain in 13-26% of females. Painful coitus is frequently reduced after lysis of pelvic adhesions. In many surveys of postoperative bowel obstruction, abdominal surgery is the leading reason for adhesion formation.

The laparoscopic surgical technique, although associated with less adhesion formation than laparotomy, is still of a substantial risk of adhesion formation. This continues to be estimated in one extensive evaluation of second-look procedures to be 67% after fimbrioplasty and 80% following ovarian cystectomy. Adhesions developed in 40-60% of patients after laparoscopic removal of ectopic pregnancy. A preoperative bowel preparation is necessary in patients with a good reputation for previous laparotomy or with severe endometriosis, as the possibility of adhesion formation and the likelihood of bowel injury are increased. If a CO2 laser has been utilized to lyse dense adhesions, hydrodissection using the suction-irrigator probe is highly recommended to create tissue planes before dissection. Grasping forceps will also be essential for applying traction to the ovary, tube, intestines, or abdominal wall to ensure that an airplane of dissection can be identified. Whenever you can, either the adhesions or ovarian ligaments should be grasped instead of the ovarian cortex to reduce trauma. For delicate microscopic procedures for example fimbriolysis and salpingo-ovariolysis, the microscissors or Ultrapulse CO2 laser is preferable, as thermal damage can happen with electrosurgery and also the fiber laser (Nd:YAG, KTP, or argon).

Factors which contribute to a heightened chance of gastrointestinal injuries include failure to determine a sufficient pneumoperitoneum, using dull trocars which require excessive force, uncontrolled, sudden entry of sharp instruments, and gastric distention. Poorly controlled or sudden trocar entry can lead to rectosigmoid laceration. Gastric distention can displace the transverse colon toward the pelvis, where it may be punctured through the Veress needle or lacerated using the trocar. This complication could be eliminated using a nasogastric tube intraoperatively.

The rectosigmoid can be injured if the depth of penetration by endometriosis is underestimated or even the cul-de-sac is obliterated. When the rectum is adherent to the posterior aspect of the cervix or uterosacral ligaments, blunt dissection may lacerate the rectum. Sharp dissection with scissors or the CO2 laser is usually recommended. The combination of high-power superpulse or ultrapulse CO2 laser and hydrodissection is comparatively safe for working round the bowel.

When the cul-de-sac is dissected, identification from the vagina and rectum is facilitated by placing a probe or perhaps an assistant finger both in the vagina and rectum. Dissection must start lateral to the uterosacral ligaments, where anatomy is less distorted, and proceed toward the obliterated cul-de-sac. Similarly, when posterior culdotomy is conducted for tissue removal or during laparoscopic hysterectomy, correct identification of vagina and rectum is important.

With regards

M.K. Gupta
re: abdominal pain by cheryl govender - Dec 28th, 2012 10:57 pm
cheryl govender
cheryl govender
I have abdominal ahesions and its very painful
I live on injection.

Dear Govender

Laparoscopic Adhesiolysis is a good surgical option in your case and to prevent recurrence interceed can be used. Interceed reduces adhesion formation by forming a continuous protective coating over raw tissue surfaces. Maintains its integrity as a barrier during the period of peritoneal healing and is absorbed from the tissue site within 4 weeks.

With regards

Dr M.K. Gupta
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