Page 25 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Current status postoperative abdominal adhesions
adhesions in 94% of all patients [17, 22]. Nevertheless, the clinical and economic significance of this high incidence was not yet completely understood and from that perspective the importance of the efforts of
the Surgical and Clinical Adhesions Research (SCAR) study group cannot 2 be overestimated [23]. They demonstrated in their first study that 34.6%
of all 27790 patients who underwent pelvic or abdominal surgery were readmitted to the hospital for a disorder directly or possibly related to adhesions with a mean of 2.1 in 10 years.
Abdominal adhesions contribute to an increased risk of small bowel obstruction (SBO), difficulties at reoperations, infertility in women and they are associated with chronic abdominal pain [21, 24-28]. Small bowel obstruction, a potentially lethal and common disorder in surgical practice, is caused by adhesions in 60-70% of all cases. In the follow- up study of the LAPAD trial (Laparotomy or Laparoscopy and Adhesions study) was shown that patients undergoing surgery on the lower gastrointestinal tract and patients with more severe adhesions present at surgery have an increased risk for small bowel obstruction [29].
Additionally adhesions are responsible for 20-40% of all female patients with secondary infertility. Furthermore, during relaparoscopy or relaparotomy various problems with adhesions can be encountered; adhesiolysis may result in a prolonged operation time, more conversions and increased intra-operative complications consequently resulting in higher morbidity and mortality. Moreover trocar placement was the most common cause of inadvertent enterotomy in a collective review of laparoscopy induced bowel injury. In 68.9% of instances of bowel injury, adhesions or previous laparotomy were noted [30, 31].
The role of abdominal adhesions as cause of chronic abdominal pain is still widely under debate. Traction of adhesions on the peritoneum and viscera, nerve fibers in adhesions itself or changes in the nervous system are all mechanisms which are suggested to contribute to chronic abdominal pain caused by adhesions when other organic and functional diseases are excluded [26]. Despite these different hypotheses it has been shown that laparoscopic adhesiolysis was of equal benefit to
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