Two Cases of Laparoscopic Adhesiolysis for Chronic Abdominal Pain without Intestinal Obstruction after Total Gastrectomy
A 71-year-old male was diagnosed with early gastric cancer in December, 2007. The cancer was located in the lower third and greater curvature of the stomach, so we performed distal gastrectomy. However, five days later, the patient underwent total gastrectomy because the proximal resection margin was found to be positive on pathologic analysis. His postoperative clinical course was uneventful.\nDuring follow-up, he complained of intermittent chronic abdominal pain lasting for two years. The pain remained refractory to several courses of medical treatment and worsened. He weighed 53 kg before the first operation and 45 kg two years later. The results of many diagnostic tests were nonspecific. There was no recurrence or intestinal obstruction on abdominopelvic computed tomography (CT) () and simple abdominal X-rays revealed mild paralytic ileus without definite intestinal obstruction ().\nWe decided to perform diagnostic laparoscopy to determine the cause of his chronic abdominal pain in November, 2009. The patient was placed in the supine reverse Trendelenburg position under general anesthesia. Three working ports, including a right lower anti-Mcbourney points port inserted by the open method, were placed. The operation took two hours with 100 ml of blood loss. The operative findings were multiple dense adhesions in the small bowel mesentery (). He recovered without any complications and the abdominal pain disappeared immediately after surgery. He is currently doing well with no abdominal pain and his weight has increased from 45 kg to 51 kg.