diagnostic laparoscopy is often used to identify specific intraabdominal pathology as the cause for chronic abdominal and pelvic pain . however , few studies have determined that laparoscopic adhesiolysis , as the only operative intervention , ameliorates a significant amount of chronic abdominal pain . furthermore , only anecdotal reports of the role of laparoscopic adhesiolysis in the setting of acute or chronic bowel obstruction have been published . our study was designed to investigate the role of laparoscopic adhesiolysis in the treatment of patients with chronic abdominal pain or recurrent bowel obstruction , not attributed to other obvious pathology . between september 1996 and april 1999 , hospital records of 35 patients who underwent laparoscopic adhesiolysis were retrospectively reviewed . fifteen patients , who had other major abdominal procedures in conjunction with adhesiolysis , were excluded from the study . these procedures included cholecystectomy ( 7 ) , repair of incisional hernia ( 2 ) , appendectomy ( 2 ) , gastrostomy ( 2 ) , colon resection ( 1 ) , and nissen fundoplication ( 1 ) . the extensive adhesiolysis in these 15 patients who were operated on for other specific pathologies was considered incidental . therefore , these patients were excluded from our study . after obtaining approval from the institutional review board assessment of symptomatic relief was determined by the questionnaire , and peri - operative morbidity and mortality were assessed by reviewing the inpatient and outpatient charts as well as through the review of the responses to the questionnaires . of the 20 patients who underwent adhesiolysis only , 2 patients were lost to follow - up . patients comprised 17 females and 1 male , with a mean age of 52 years ( range 35 to 78 ) . all operations were completed by 1 surgeon experienced in laparoscopy , at a major medical institution under general anesthesia . thirteen operations were undertaken for chronic abdominal / pelvic pain , and 5 for bowel obstruction . of the 5 patients with bowel obstruction , 3 were hospitalized with acute bowel obstruction ; and 2 were operated on electively for treatment of chronic , intermittent bowel obstruction . the average number of previous abdominal procedures was 2.6 ( range 1 - 4 ; table 1 ) . preoperatively , patients were worked up extensively with a combination of computerized tomography of the abdomen and pelvis , upper and lower gastrointestinal contrast studies , and upper and lower gastrointestinal endoscopies . these studies were obtained to rule out obvious intraabdominal / visceral pathology that would explain the patient 's chronic abdominal pain , intestinal obstruction , or both . only when all studies were considered negative for such processes were the patients considered for laparoscopy and adhesiolysis . prior abdominal / pelvic surgeries preoperative evaluation postoperatively , 14 of the 18 patients had complete resolution of their symptoms , and an additional 2 patients had partial resolution of their symptoms ( overall 88.9% response to adhesiolysis ) . seven of these 16 patients reported recurrence of some of their symptoms from 1 week to 6 months following their adhesiolysis . after a mean follow - up period of 11 months ( range 1  32 months ) , overall , 14 patients ( 77.8% ) reported an improvement in their quality of life and responded that they would have the adhesiolysis again . three patients continue to require intermittent use of medications for pain control . of the 18 operations performed , 3 resulted in enterotomies , 2 of which required conversion to laparotomy for resection of devitalized bowel . the 3 enterotomies were encountered in the 3 patients hospitalized preoperatively with acute bowel obstruction . the 15 patients who did not suffer enterotomies were all discharged within 24 hours after their operations . the remaining 3 patients were discharged from 10 days to 21 days following their operations . another patient who required laparotomy for bowel resection underwent a subsequent laparotomy for recurrent bowel obstruction . six other patients have been hospitalized for unrelated medical and surgical conditions ( table 3 ) . intestinal obstruction is commonly attributed to intraabdominal scar tissue , a claim that is frequently substantiated by operative findings in patients requiring surgical intervention . abdominal and pelvic pain in association with intraabdominal scar tissue are not as well understood . mueller and kresch have suggested that adhesions can be the cause of pain if they limit the movement or distensibility of peritoneum or bowel . stretching pain secondary to adhesions attached to the liver , intestine , or other organs may also contribute to chronic abdominal pain ; and the adhesions can partially or intermittently cause intestinal obstruction . one study noted that small adhesions appear to cause recurrent pain without other symptoms , whereas large adhesions produce pain in combination with symptoms indicative of intermittent bowel obstruction . enthusiasm for elective adhesiolysis is often limited by the concern about subsequent scar tissue formation following major laparotomy . although the etiology for intraabdominal scar tissue formation is likely to be multifactorial , the inflammatory response , which is decreased in laparoscopy versus laparotomy , has been considered a cause for subsequent scar tissue formation . therefore , it is possible that laparoscopic adhesiolysis would result in immediate resolution of symptoms attributed to intraabdominal adhesions , with less likelihood of subsequent recurrence of adhesions and symptoms . our operative technique includes complete lysis of all adhesions that have resulted in fixation of the small and large intestine to the abdominal wall . except in those patients with operative findings of an obvious transition from dilated to decompressed bowel , we do not routinely inspect the entire length of the small intestine , searching for interloop adhesions . we believe excessive manipulation of the small intestine may increase the risk of enterotomies . so far , with a mean follow - up of 11 months , the only patient who has required repeat abdominal surgery for recurrent symptoms is 1 of the 3 patients who required major bowel resection at the time of her initial adhesiolysis , supporting the adequacy of our technique of adhesiolysis . identification of other intraabdominal pathology through the extensive use of less - invasive preoperative testing should result in a low incidence of nontherapeutic adhesiolysis . fifteen patients excluded from our study had other major abdominal procedures performed at the time of their adhesiolysis . all of these patients were extensively evaluated preoperatively and found to have other possible sources for their chronic abdominal pain . during their operations , however , all 15 patients underwent similar extensive adhesiolysis to prevent a future operative procedure . we believe that an extensive pre - operative workup should be used before attributing symptoms of chronic abdominal pain to intraabdominal scar tissue . additionally , we believe that patients with unusual preoperative abdominal pain should undergo adhesiolysis at the time of their laparoscopy for other preoperatively detected intraabdominal pathology . as early as 1992 , several authors suggested that laparoscopy in the setting of bowel obstruction may yield inadequate enterolysis , and is likely to be dangerous . more recently , other authors have demonstrated acceptable results with laparoscopic lysis of adhesions in the setting of acute intestinal obstruction . in our study , all 3 patients who underwent adhesiolysis after hospitalization for acute bowel obstruction sustained enterotomies . one was repaired laparoscopically , but 2 required conversion to laparotomy for resection of devitalized bowel , and 1 of the 2 patients has since required another operative procedure for recurrent bowel obstruction . in contrast , the 2 patients who underwent adhesiolysis for management of chronic bowel obstruction had no operative morbidities . based on this experience , we conclude that laparoscopic adhesiolysis performed for management of acute bowel obstruction may result in a high incidence of operative complication . an overall 77.8% improvement in symptoms following laparoscopic adhesiolysis supports liberal use of diagnostic laparoscopy and lysis of adhesions in patients with chronic abdominal pain , bowel obstruction , or both , who have previously under - gone major abdominal surgery . to improve the yield of such an approach , in conclusion , laparoscopic adhesiolysis for chronic abdominal pain , recurrent bowel obstruction , or both , is safe and effective and results in minimal peri - operative morbidity . in the setting of acute bowel obstruction ,