Page 142 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Chapter 8
Discussion
This retrospective study on the long term complications after acute and elective operation in case of diverticulitis shows that the severity of the abdominal complaints is neither influenced by the stage of the disease nor whether it was performed in an acute or elective setting.
Post-surgical abdominal adhesions contribute to an increased risk of small bowel obstruction, difficulties at reoperations and infertility in women [15-17]. Every abdominal operation can induce adhesion formation, although in general it has been shown that laparotomy results in more adhesion formation than laparoscopy [18-21]. Another cause for the formation of adhesions is the presence of localized or generalized peritonitis [22, 23]. In this respect it has been shown that after perforated appendicitis the incidence of adhesion-related small- bowel obstruction significantly increases compared to non-perforated appendicitis [24, 25].
Abdominal adhesions are also associated with chronic abdominal pain; nevertheless this relation has been subject of discussion for decades. It has been suggested that traction of adhesions on the peritoneum and viscera, nerve fibres in adhesions itself, or changes in the nervous system might contribute to chronic abdominal pain caused by adhesions when other organic and functional diseases are excluded [1, 4]. However, other studies and this data does not support that relationship [2, 3].
Provided that abdominal adhesions can cause chronic abdominal pain, one might expect more complaints after open surgery and/or operation for Hinchey type III and IV. In this study, almost all operations in the acute setting were performed using the open technique (95 out of 96) and when patients were diagnosed with Hinchey classification III or IV they were directly operated on (70 out 74). Therefore, we hypothesized that patients operated in the acute setting might have more abdominal complaints after long-term follow-up. However, neither the timing of operation nor Hinchey classification proved to be a risk factor for abdominal complaints on the long term. Additionally, no significant
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