Scar Tissue Surgery Doesn't Seem to Help Chronic Abdominal Pain

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Abdominal Pain Surgery of Little Value

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.

In this study, Swank and colleagues from the Groene Hart Hospital, Netherlands, recruited 100 patients (87 women and 13 men) who had undergone prior surgeries for chronic abdominal pain. Half got the scar removal surgery and the other half had diagnostic laparoscopy without removal of adhesions.

The patients were followed for the next year, during which time pain was assessed through a variety of methods. Both groups reported substantial improvement in their chronic abdominal pain and improved quality of life a year after surgery. The degree of pain relief was similar for both groups. Swank attributes the pain relief in both groups to the placebo effect. The findings are published April 12 in the journal The Lancet.

Reproductive endocrinologist and adhesion specialist Michael P. Diamond, MD, tells WebMD the main downside to scar removal surgery is not that it doesn't work, but that it doesn't work for very long. In his own studies, adhesions recurred in more than 95% of patients who have the surgery.

"The literature suggests that 70% to 80% of patients will experience a reduction in pain with this surgery, but these studies don't follow patients very long," says Diamond, who directs the division of reproductive endocrinology and infertility at Detroit Medical Center and Wayne State University. "The truth is that our ability to help patients with longstanding pain who have had multiple surgeries is not at all what we would like it to be."

SOURCES: The Lancet, April 12, 2003. Dingeman J. Swank, MD, department of surgery, Groene Hart Hospital, Gouda, Netherlands. Michael P. Diamond, MD, professor of obstetrics and gynecology and director of the division of reproductive endocrinology and infertility at the Detroit Medical Center and Wayne State University, Detroit .

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