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Big Fibroid operation refused in U.K & Was done successfully laparoscopically in India


Laparoscopic Surgeries > Laparoscopic Adhesiolysis
  Laparoscopic Adhesiolysis  

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Performed for pain in lower abdomen or found during laparoscopy for Infertility or any other indications.


PID, Tuberculosis, Endometriosis & past surgeries are the commonest causes of adhesions around pelvic genital organs and anterior abdominal wall. Tubercles with intestinal adhesions & adhesions all over abdomen & around liver, we suspect Abdominal Tuberculosis. Here we give adequate AKT before attempting Adhesiolysis. Aim of Adhesiolysis during diagnostic laparoscopy is to establish Tubo-ovarian relationship. Post Laparotomy adhesions are found in 20-70% of cases following various Gynecological surgeries leading to subsequent abdominal wall adhesions & posy operative pain requiring Laparoscopic Adhesiolysis. Fact may inspire all patients to ask primary surgeon for not offering initial Gynaec surgery by Laparoscopic approach. Adhesiolysis is the most rewarding surgery in pain relief.

Benefits of Laparoscopy Surgery:

  • Shorter Hospital stay.
  • Earlier return to your routine work.
  • Cosmetically vary small scar.
  • Less pain after operation.
  • Best fertility enhancement & Fertility results following Laparoscopy.
  • Video-live operative file available in CD/DVD for future reference (Transparency about surgical procedure).
  • The possibility of post-operative adhesion formation will be less, and the possibility of pain because of post-operative adhesions will also be less.  

Pre-operative Check Lists:

  1. Lab. Investigation for Surgery (Urine complete & Blood complete, HbsAg, HIV, R.B.S. etc.); Pelvic Trance vaginal USG report
  2. Specific Investigations for Infertility (Endocrine, Blood, Genetic, Husband’s Semen report etc.) If the couple is infertile.
  3. Operation planned from 4th to 10th day of Menstrual Cycle if Laparoscopy is done for Infertility.
  4. Enema & preparation/shaving of local parts.

No. Of Cuts on Abdomen:
Three cuts: all of 5 mm size.

Average Stay in Hospital:
4 to 6 hours. (DAY CARE SURGERY)

Average Duration of Surgery:
30-40 minutes

Average Blood loss during Surgery:
10-30 cc

Average time after operation to resume normal activities/work:
Within 24 hours.

General Anesthesia (Patient will not feel any pain in Operation Theatre during surgery)

Operative Procedure:

Inside the Umbilicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images - and sends them to a monitor so the surgeon can see what is going on inside.

Performing laparoscopy usually only requires three tiny incisions less than one half inch, (about 5-10 millimeters) in length. With previous midline scar on abdomen, we generally introduce verres needle through palmer’s point and then first 5 mm port is introduced through Palmer’s point.  . This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable. With help of palmer’s point port, second 5 mm port is kept suprapubically on vision above the midline intra abdominal midline adhesions. Third port is kept on Lt side near anterior superior iliac spine on vision. Adhesiolysis is dine with Bipolar & scissor and adhesions are stretched from one side simultaneously.

Most of the time many patients undergo laparoscopy as Day care procedure, returning home within 24 hours of surgery. For normal laparoscopy procedure takes about 15 to 35 minutes only. For more complicated case it may take 1-2 hour. Most begin feeling much better within one day.

Post-operative Course:

  • Patient remains drowsy/sedated for 2-3 hours after laparoscopy but conscious & pain free.
  • Patient can take fluids 3-4 hours after laparoscopy & light food after 4-6 hours.
  • She may feel little abdominal & shoulder pain after laparoscopy for 24 hours but it cam be relived with pain killer tabs.
  • Most of the patients can walk normally without support and can take normal diet 6-8 hours after the laparoscopy.
  • She can be discharged on the same day of the operation.
  • Few patients may feel nausea & vomiting after laparoscopy, which can be very well controlled with injection in post-operative room.
  • Patient can do her normal activity within 24 hours after laparoscopy. Patient is advised to take antibiotics & analgesic tabs.
  • for 5 days following laparoscopy.
  • Patient is advised to report to doctor for severe pain or bleeding or fever in postoperative period (Day-1 to Day-5) immediately.
  • Patient is advised to come for follow up 7 days after the Laparoscopy for dressing.

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