Adhesions of the small bowel are often found after abdominal operations or following abdominal inflammation like appendicitis, adnexitis etc. Fibrin webs and adhesions form between the bowel loops and hamper motility and compliance of the bowel wall. This leads to discomfort, distension and cramps after eating. In the worst case a complete stop of passage occurs: this condition is known as bowel obstruction. More about this topic later on. Adhesions cannot be visualized with normal imaging techniques like ultrasound, CT-scan or MRI. Their presence can only be suspected when they cause significant obstruction and change the contour of the bowel.
The role of the surgeon comes in when the complaints continue or worsen. Before the era of laparoscopy surgeons were reluctant to operate for adhesions. An open operation causes more damage and in the end leads to more adhesions than before. Therefore an operation was acceptable only when complete bowel obstruction was present.
With minimal invasive (laparoscopic) surgery we can now deal with adhesions without causing further damage and new adhesions. At the same time additional diagnostic information is gained on the abdominal organs and structures seen during laparoscopy. Under the section diagnostic laparoscopy several examples of intraoperative findings during laparoscopy are shown.