Adhesion‐Related Complications Are Common, But Rarely Discussed in Preoperative Consent: A Multicenter Study

Rajab, Taufiek Konrad; Wallwiener, Markus; Talukdar, Sabrina; Kraemer, Bernhard

doi:10.1007/s00268-008-9917-x

Cited by 53 publications

(39 citation statements)

References 36 publications

(38 reference statements)

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“…Yet preoperative discussion often does not include the possible late complications resulting from adhesions. 34 The risk of intestinal obstruction should be discussed with patients and families during consent for radiotherapy and surgery, as well as throughout treatment. Furthermore, survivors of childhood cancer should be followed regularly to reinforce the signs and symptoms of intestinal obstruction.…”

Section: Intestinal Obstruction In Survivors Of Childhood Cancermentioning

confidence: 99%

Intestinal Obstruction in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

Madenci

Fisher

Diller

et al. 2015

JCO

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Purpose For adult survivors of childhood cancer, knowledge about the long-term risk of intestinal obstruction from surgery, chemotherapy, and radiotherapy is limited. Methods Intestinal obstruction requiring surgery (IOS) occurring 5 or more years after cancer diagnosis was evaluated in 12,316 5-year survivors in the Childhood Cancer Survivor Study (2,002 with and 10,314 without abdominopelvic tumors) and 4,023 sibling participants. Cumulative incidence of IOS was calculated with second malignant neoplasm, late recurrence, and death as competing risks. Using piecewise exponential models, we assessed the associations of clinical and demographic factors with rate of IOS. Results Late IOS was reported by 165 survivors (median age at IOS, 19 years; range, 5 to 50 years; median time from diagnosis to IOS, 13 years) and 14 siblings. The cumulative incidence of late IOS at 35 years was 5.8% (95% CI, 4.4% to 7.3%) among survivors with abdominopelvic tumors, 1.0% (95% CI, 0.7% to 1.4%) among those without abdominopelvic tumors, and 0.3% (95% CI, 0.1% to 0.5%) among siblings. Among survivors, abdominopelvic tumor (adjusted rate ratio [ARR], 3.6; 95% CI, 1.9 to 6.8; P < .001) and abdominal/pelvic radiotherapy within 5 years of cancer diagnosis (ARR, 2.4; 95% CI, 1.6 to 3.7; P < .001) increased the rate of late IOS, adjusting for diagnosis year; sex; race/ethnicity; age at diagnosis; age during follow-up (as natural cubic spline); cancer type; and chemotherapy, radiotherapy, and surgery within 5 years of cancer diagnosis. Developing late IOS increased subsequent mortality among survivors (ARR, 1.8; 95% CI, 1.1 to 2.9; P = .016), adjusting for the same factors. Conclusion The long-term risk of IOS and its association with subsequent mortality underscore the need to promote awareness of this complication among patients and providers.

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Section: Intestinal Obstruction In Survivors Of Childhood Cancermentioning

confidence: 99%

Intestinal Obstruction in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

Madenci

Fisher

Diller

et al. 2015

JCO

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“…Postoperative intraperitoneal adhesions still represent a clinical burden [1,2] causing relevant postoperative complications [3] including chronic pain [4][5][6], bowel obstruction [7,8], infertility [9,10], increased rates of reoperation [11], extended operation time [12] and increased operation risk of subsequent interventions [13,14] as well as substantial costs affecting the healthcare system [15,16]. Serosal wound healing is a complex process which includes inflammation [17], fibrin exudation [18] and remesothelialization [19], the latter being apparently disturbed when adhesion formation occurs.…”

Section: Introductionmentioning

confidence: 99%

Mesothelial morphology and organisation after peritoneal treatment with solid and liquid adhesion barriers–a scanning electron microscopical study

Brochhausen

Schmitt

Rajab

et al. 2012

J Mater Sci: Mater Med

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Separation of traumatized tissue represents the only promising strategy in postoperative adhesion prevention, a relevant clinical problem after surgical intervention. In the present study scanning electron microscopy (SEM) and subsequent morphometry were used to analyse the tissue response to five commercial adhesion barriers. Standardised peritoneal lesions in Wistar rats were covered with solid and viscous barrier materials and semiquantitatively analysed 14 days postoperatively. Striking morphological differences in lesion surface organisation between the barrier groups became apparent with colonisation of the barrier by mesothelial cells to different degrees. Furthermore, the mesothelial cells showed either a normal or activated phenotype depending on the underlying biomaterial. These experiments demonstrate that the examination by SEM gives useful insights into the performance of barrier materials and the cellular processes of adhesion prevention, since mesothelial cells play an active role in the pathogenesis of adhesion formation.

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“…The incidence of postsurgical peritoneal adhesions increased over the past decades [1][2][3][4]. Peritoneal adhesions cause significant morbidity, including intestinal obstruction, infertility, and chronic abdominopelvic pain and are associated with multiple surgical complications [5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Influence of small intestinal serosal defect closure on leakage rate and adhesion formation: a pilot study using rabbit models

Binnebösel

Klink

Grommes

et al. 2010

Langenbecks Arch Surg

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Closure of isolated serosal injuries with resorbable suture material was associated with an adhesion formation in distressing certainty, whereas no leakage or fistula formation could be observed at all. Further studies are needed to clarify the impact of serosal defect closure in particular on leakage rate and fistula formation, e.g., with pre-existing adhesions, in case of multiple serosal injuries or with a pre-existing peritonitis.

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Adhesion‐Related Complications Are Common, But Rarely Discussed in Preoperative Consent: A Multicenter Study

Abstract: Preoperative informed consent does not adequately reflect the magnitude of adhesion-related problems. These findings have immediate implications for clinical practice.

Cited by 53 publications

References 36 publications

Intestinal Obstruction in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

Intestinal Obstruction in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

Mesothelial morphology and organisation after peritoneal treatment with solid and liquid adhesion barriers–a scanning electron microscopical study

Influence of small intestinal serosal defect closure on leakage rate and adhesion formation: a pilot study using rabbit models

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