LAPAROSCOPICAL EXAMINATION IN PATIENTS WITH POSTOPERATIVE SCAR FORMATION OF THE ABDOMINAL WALL

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The performance of laparoscopy in patients in whom a surgical operation in the abdomen has been formerly done, tends to be considered difficult, because it is supposed that a surgical operation results mostly in adhesions in the abdominal cavity, though they have a variety in extent and thickness. In order to clarify this problem, the authors investigated 289 cases, which were laparoscopically examined in last two years in our clinic. At the time of laparoscopy, 24 of these 289 cases had already an anamnesis of laparotomy, because of either digestive or gynecological diseases, while surgical operation against respectively acute appendicitis and hernia of the abdominal wall was ignored in this study, because laparoscopy has never been disturbed practically after these operations. In 20 of 24 cases, laparoscopy was successfully performed, but in the residual 4 cases, laparoscopical success was missed. Unsuccessfulness was concerned with, on the one hand, unsuccessful insertion of laparoscope into the abdominal cavity because of insufficient fullness of pneumoperitoneum and, on the other hand, impossible laparoscopical observation after insertion of laparoscope due to wide and thick postoperative adhesions. As the insufficient fullness of pneumoperitoneum might be also caused by postoperative adhesions in the abdominal cavity, it might be said that the unsuccessful laparoscopy in patients with the early anamnesis of surgical operation in the abdominal region was due to the postoperative abhesions. Two of unsuccessful 4 cases had undergone hysterectomy, 1 cholecystectomy and the last one cholecystectomy following with hysterectomy. However, it can not always be said that laparoscopy after hysterectomy or cholecystectomy results in unsuccessness, because 2 cases with the early anamnesis of hysterectomy and a case with that of cholecystectomy were contained in the group of 20 successful cases. There was no definite difference in interval from the time of surgical operation to that of laparoscopy between the successful and the unsuccessful group. In a short word, it can be said that laparoscopical examination in patients with postoperative scar formation of the abdominal wall has brought success in about 83.3% of cases. In 9 of 265 cases without postoperative scar formation of the abdominal wall, success of this diagnostic procedure was missed; in 3 of them because of the impossible insertion of laparoscope following the insufficient fullness of pneumoperitoneum, in another 3 patients because of sensitiveness, in a patient because of subcutaneous emphysema, in another patient because of inguinal hernia, and in a last patient because of impossible observation of the abdominal organs due to the wide and thick adhesions. In the last case, the cause of adhesions was unknown. Therefore, we can say that laparoscopical examination in patients without postoperative scar formation of the abdominal wall obtains success in 93.6% of the cases. Based upon these facts, it might be conclcded that the laparoscopical examination is a useful diagnostic procedure in patients with postoperative scar formation of the abdominal wall as well as in patients without of it, though possibility of success in the former group is lesser in 13.3% than that of the latter.
社団法人日本消化器内視鏡学会の論文

LAPAROSCOPICAL EXAMINATION IN PATIENTS WITH POSTOPERATIVE SCAR FORMATION OF THE ABDOMINAL WALL

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