[Impact of laparoscopic surgery in the treatment of chronic XXXX ].

@entity1 @entity391 @entity1661 @entity260 @entity1104 @entity158 @entity490 @entity516 @entity393 @entity1142 @entity121
Chronic @entity490 is becoming increasingly important with regard to the quality of life of the @entity1 and its social and economic impact, in terms of cost of hospitalization, @entity393 due to sick leave, and pharmaceutical costs for treatments which fail to offer either significant clinical improvement or resolution of the @entity158 symptoms. The main symptom is chronic @entity490 , which may vary in intensity and may be associated with @entity1142 and episodes of @entity391 , when the clinical picture evolves toward one of subocclusion or total occlusion of the bowel. We considered the following criteria in our selection of @entity1 for this study: 1) quality of life, 2) constant use of antispastic and analgesic medications, 3) absence of any other diagnosticable pathology prior to the operation. From August 1992 to April 2000 we operated on 105 @entity1 with this syndrome (16 males and 89 females). Among these 8 @entity1 had never been subjected to a laparotomy, while 97 had previously undergone surgical procedures (126 laparotomies). In the first 85 @entity1 in the series (81%) we used a 10 mm laparoscope (0-30 degrees) to evaluate the presence of @entity1661 based on the type of surgery the @entity1 had undergone previously, as well as the location of the @entity158 reported by the @entity1 . In 41 cases (48.2%) the @entity516 was obtained with the Veress needle. In another 44 cases (51.8%) the Hasson technique was used. Since June 1999, we have carried out the exploration of the abdominal cavity in 20 @entity1 (19%) using a trocar and 2.2 mm laparoscope in the left hypochondrium along with a mini-trocar placed either in the right or left flank. (The positioning of the trocars depended on the previous surgical procedures performed). The exploration included inspection of the abdominal cavity. In 8 of the @entity1 the procedure was carried out under local anaesthesia We performed laparoscopic adhesiolysis in 93 cases; in 7 cases no signs of @entity1104 were seen, while in another 5 cases it was necessary to convert the original laparoscopic procedure to a laparotomy. The types of @entity1104 found were fine-filmy (46%), dense-vascularised (46%), and cohesive (16%). In 6 cases during lysis of the @entity1104 complications of @entity121 occurred, which required laparotomic repair. In 5 cases we diagnosed a pathological condition which was not suspected. The average postoperative hospital stay was 2 days (range: 1-7); no major @entity260 were noted. In the course of the follow-up of 78 @entity1 over an average of 37 months (range: 6-72) the results obtained were as follows; 47 @entity1 (60.2%) had complete @entity158 relief, 18 @entity1 (23.1%) had partial @entity158 relief, and the remaining 13 @entity1 (16.7%) had no significant @entity158 relief. Laparoscopic exploration in @entity1 with chronic @entity490 is technically feasible in a simple manner in most @entity1 . By means of careful and accurate preoperative selection of the @entity1 partial if not complete @entity158 relief can be achieved in a high percentage of cases (83.3% in our series).
