Chapter 23 Laparoscopic management and prevention of pelvic adhesions and postoperative pain

The consequences of pelvic surgery can include postoperative pain, adhesion formation, a recovery period, and postoperative fatigue. For the same intervention, laparoscopic surgery is considered superior to laparotomy since it is associated with less pain, a faster recovery, a shorter hospitalization period, and a more aesthetic scar. Laparoscopic surgery moreover is also believed to be less adhesiogenic because the magnification of the surgical field and smaller instruments would permit a more precise surgery. This chapter will present a mix of experimental data from animal models and observational medicine. We will emphasize the central role that acute inflammation of the peritoneal cavity plays in postoperative pain, adhesion formation, recovery, and fatigue. This should illuminate the pathophysiology of healing and recovery and thus aid in prevention of undesirable effects. In addition, this will highlight the differences between surgery by laparoscopy and by laparotomy, which requires a large incision in the abdominal wall. The role of the peritoneal cavity might also give a glimpse of the future directions of surgery both for the patient’s benefit and for the health care costs. These include both the direct costs of surgery and analgesics; and the indirect costs of recovery, fatigue, absence from work; and the costs related to adhesion formation such as chronic pain, infertility, reoperation, and possibly ovarian damage and tumor metastasis.