Adhesions after abdominal surgery: a systematic review of the incidence, distribution and severity

Abstract

Abdominal adhesions are associated with increased postoperative complications, cost and workload. We performed a systematic review with statistical pooling to estimate the formation rate, distribution and severity of postoperative adhesions in patients undergoing abdominal surgery. A literature search was carried out for all articles reporting on the incidence, distribution and severity of adhesions between January 1990 and July 2011. Twenty-five articles fulfilled the inclusion criteria. The weighted mean formation rate of adhesions after abdominal surgery was 54 % (95 % confidence interval [CI] 40-68 %), and was 66 % (95 % CI 38-94 %) after gastrointestinal surgery, 51 % (95 % CI 40-63 %) after obstetric and gynaecological surgery and 22 % (95 % CI 7-38 %) after urological surgery. The mean overall severity score was 1.11 ± 0.98 according to the Operative Laparoscopy Study Group classification. Laparoscopic surgery reduced the adhesion formation rate by 25 % and decreased the adhesion severity score (laparoscopic; 0.36 ± 0.69 vs. open; 2.14 ± 0.84) for gastrointestinal surgery. Our results demonstrate that the incidence and severity of abdominal adhesions varies between surgical specialties and procedures. An increased awareness of adhesions can help in identifying the underlying mechanisms of adhesion formation and novel therapeutic approaches, while also improving the surgical consent process.

Successful treatment of quintuple primary cancer, including esophageal cancer: A case report

“…This can be prevented by performing thoracoscopic or laparoscopic surgery. Each method yields a considerable benefit in the reduction of post-operative adhesions and leads to an easier procedure when surgery is subsequently performed (18). In the present case, gastric tube resection was performed using a right thoracotomy approach subsequent to esophagectomy, due to the decreased adhesions.…”

Risk Factors for the Development of Adhesive Small Bowel Obstruction after Abdominal and Pelvic Operations

“…These include the Operative Laparoscopy Study Group (OLSG), American Fertility Society (AFS), Bristow and Suhlke scoring systems. Each of these systems rates the density and physical severity of the adhesions [1]. However, there is no scoring system that addresses a patient's risk of development of symptomatic adhesions based on prior relevant historical factors.…”

“…For example, the use of laparoscopy has been shown to decrease the formation of peritoneal adhesions and adhesion related readmissions [1]. Additionally, adjunctive measures such as hyaluronic acid-carboxymethylcellulose membrane (Seprafilm™ -Genzyme, Cambridge, MA), Icodextrin solution (Adept™ -Baxter International, Deerfield, IL), knitted fabric of modified cellulose (Interceed™ -Johnson and Johnson, New Brunswick, NJ), or polyvinyl alcohol-based gels such as A-Part Gel™ -Aesculap AG, Tuttlingen, Germany) have also been shown to decrease adhesion burden to some extent.…”

Validation of peritoneal adhesion index as a standardized classification to universalize peritoneal adhesions definition

“…However there are not significant differences in PAI score based on previous surgical access (open vs laparoscopic, P=0.352). On the one hand in some studies laparoscopy in gastrointestinal surgery was reported to reduce the adhesion formation rate by 25% and to decrease the adhesion severity score, 10 but the level of evidence is low. 17 On the other hand, the incidence of adhesion-related post-operative obstruction was studied in two randomized prospective trials.…”

“…As a matter of fact, in the USA in 1996 the total annual cost for adhesions management exceeded $ 2 billion. 10,11 Therefore, different classification systems were suggested, 12,13 however they did not provide the univocal definition for adhesions under both a quantitative and a qualitative point of view. At present it is not possible to analytically standardize adhesions.…”