Page 127 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Long-term follow-up after appendectomy
Among the 526 responders only reoperation within 30 days after the initial operation resulted in significant more abdominal complaints in 10 out of 18 patients (Table 3). Reoperations were performed by midline laparotomy in 16 cases. Of the patients who experienced abdominal complaints during the previous six months 7 out of 10 were additionally reoperated for incisional hernia (4), small bowel obstruction (1), bowel resection for carcinoid tumour (1) and multiple gynaecological operations (1). In the group without abdominal complaints only 1 out of 8 patients was reoperated for incisional hernia.
Discussion
The results of our study show that after long-term follow-up the incidence of abdominal complaints was not influenced by laparoscopic
or open approach nor whether the acute appendicitis was complicated
or not. In literature it has been suggested that traction of adhesions on
the peritoneum and viscera, nerve fibers in adhesions itself or changes in
the nervous system might contribute to chronic abdominal pain caused 7 by adhesions when other organic and functional diseases are excluded
[10]. However, our data does not support a causative role for adhesions with regard to chronic abdominal complaints.
Perforated appendicitis is an independent risk factor for SBO caused by abdominal adhesions as the result of localized or generalized peritonitis [5-7]. Provided that these adhesions can cause abdominal pain one might expect more abdominal complaints after complicated appendicitis. Tingstedt et al demonstrated in their retrospective study that resection of a normal appendix as well as complicated appendectomy resulted in a higher readmission rate within 7 years. This was in majority of all cases (45%) because of nonspecific abdominal pain [7]. Interestingly females were over represented in this group suggesting a different cause of abdominal complaints than appendicitis.
We hypothesized that complicated appendectomy results in increased abdominal complaints because of adhesion formation. However, the only
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