B. A. Van Den Beukel1, S. Van Leuven1, M. Stommel1, C. Strik1, M. A. IJsseldijk1, F. Joosten2, H. Van Goor1, R. P. Ten Broek1 1Radboud University Medical Center,General Surgery,Nijmegen, GELDERLAND, Netherlands 2Rijnstate Hospital,Department Of Radiology,Arnhem, GELDERLAND, Netherlands
Introduction:
Chronic abdominal pain develops in 18-40% of patients who have undergone abdominal surgery. Adhesions are associated with chronic post-operative pain; however, diagnosis and treatment is controversial. In this study we evaluate long-term pain and healthcare utilization in a prospective cohort of patients who underwent adhesion mapping by cine-MRI, with subsequent treatment determined through a shared decision-making approach.
Methods:
Patients with chronic post-operative abdominal pain with suspicion for causative adhesions underwent evaluation with cine-MRI. When adhesions were present on cine-MRI, individualized risks and benefits of adhesiolysis were discussed in a shared-decision making process. Patients who elected to undergo adhesiolysis received an anti-adhesion barrier. Pain and healthcare utilization were evaluated by questionnaire at follow up.
Results:
106 patients were recruited, with a median of 19 (range 6-47) months’ follow-up. 79 patients had adhesions on cine-MRI, 45 underwent an operation, while 34 patients elected not to pursue surgical intervention. 27 patients had no adhesions on cine-MRI, five choose to proceed with diagnostic laparoscopy. Response rate to follow-up questionnaire was 86?8%. In the operative group (Group 1), 80?0% of 45 responders reported long-term improvements in pain, compared to 42?9% (difference 37·1%; 95% confidence interval (CI): 14·4%-55·9%) in patients with adhesions on cine-MRI who declined surgery (28 responders, group 2), and 26?3% (difference 53·7%; 95%CI: 27·3%-70·8%) in patients with no adhesions on cine-MRI who declined laparoscopy (19 responders, group 3). Consultation of medical specialists was significantly lower in group 1 compared to groups 2 and 3 (35?7% vs. 65?2% vs. 58.8%; P=0?023).
Conclusion:
We demonstrate long-term pain relief in two-thirds of patients with chronic pain caused by adhesions, using cine-MRI and a shared decision making process. Long-term improvement of pain was achieved in 80% of patients who underwent surgery with concurrent application of an anti-adhesion barrier.
