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Abdominal Pain Surgery of Little Value

Scar Tissue Surgery Doesn't Seem to Help Chronic Abdominal Pain
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April 10, 2003 -- A new study shows that a common surgery for chronic abdominal pain doesn't actually seem to relieve the pain. Scar tissue in the abdomen is thought to be a common cause of chronic abdominal pain. But researchers say that doctors shouldn't recommend this surgery because the risks outweigh the benefits.

In the study, researchers looked at people with chronic abdominal pain who were found to have abdominal scar tissue (adhesions) during laparoscopic surgery -- a procedure in which a scope is inserted through several small holes in the abdomen. Half of these people then went on to have laparoscopic surgery to remove the scar tissue.

But the scar removal surgery appeared to have no effect on relieving chronic abdominal pain. The group that had only the original surgery -- without scar tissue removal -- had the same degree of pain relief.

The problem, says laparoscopic surgeon Dingeman Swank, MD, is that the rate of serious complications is relatively high with the scar removal surgery, and the patients who have it appear to fare no better than those who have diagnostic laparoscopy without removal of abdominal adhesions.

"We are not saying that diagnostic surgery should not be done, because in 5% to 7% of patients, causes for pain other than adhesions can be found and successfully treated," Swank tells WebMD. "But removing adhesions offers no benefits for patients."

Chronic abdominal pain is often difficult to diagnose and treat. And people with this condition often undergo many tests without a cause being found. Bands of scar tissue that attach to organs and other tissue can result from previous abdominal surgery, past infections, or endometriosis. Adhesions are believed to be a common cause of chronic abdominal pain, although many experts question this association.

But surgery to remove abdominal scar tissue is often the treatment of choice for chronic abdominal pain with no other known cause. But Swank says he began questioning the surgery's value after performing the procedure on some 200 patients.

"In this group of people with longstanding abdominal pain we had two deaths and a 10% incidence of serious complications, mostly bowel perforations," he says.

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