7600 Identifying Risk Factors for Adhesion Formation in the Left Upper Quadrant - Preliminary Findings of a Prospective Study

Abstract

<h3>Study Objective</h3> To identify risk factors for development of adhesions in the left upper quadrant (LUQ). <h3>Design</h3> Multi-site, prospective study approved by each institution's local institutional review board. <h3>Setting</h3> Two large academic tertiary referral centers. <h3>Patients or Participants</h3> All laparoscopic cases performed by study staff on adult patients were eligible. Cases were performed per standard protocol with entry approach and location per surgeon preference. Intraoperative photo documentation of four abdominal quadrants was obtained at the onset of each case, and additional areas as indicated. A data collection form was completed after each case to capture data on adhesiogenic events (such as prior surgeries, infections, endometriosis, radiation), time spent for adhesiolysis, route of entry, location and grade of adhesions, if present. <h3>Interventions</h3> No interventions were included in this study. The primary outcome of this study is the presence and severity of adhesions identified in the LUQ at the time of laparoscopy for benign gynecologic disease. <h3>Measurements and Main Results</h3> We present interval findings from study onset in 2019 until February 2022. A total of 520 laparoscopic cases have been collected, with an overall adhesion incidence of 59.4%. The overall incidence of adhesions present in the LUQ was 1.9%. Among patients with a history of gastric banding, sleeve gastrectomy, and Roux-en-Y bypass (n=24), there were 2 cases with adhesions in the LUQ (8.3%); one with filmy adhesions and one with dense cohesive adhesions between bowel and the anterior abdominal wall. These two patients had prior open gastric bypass and open gastric bypass revision with colectomy. No visceral or vascular injuries were noted when LUQ entry was performed. <h3>Conclusion</h3> Our early data suggests that the overall rate of adhesions in the LUQ is low, especially with prior laparoscopic gastric procedures. While a history of gastric surgery should not preclude abdominal entry in the LUQ, vigilance is important to avoid inadvertent injury to underlying structures.