Incidence of Intra-Abdominal Adhesions in a Continuous Series of 1000 Laparoscopic Procedures

Abstract

Intra-abdominal adhesions occurring after intraperitoneal surgery are responsible for a substantial proportion of cases of intestinal obstruction (74%), chronic pelvic pain (20%–50%), and female infertility (15%–20%). They increase the risk of bowel injuries during subsequent surgery. This prospective monocentric study investigated the incidence of intra-abdominal adhesions and their relationship to previous abdominal surgery for a continuous series of 1000 gynecologic laparoscopic procedures. The study was conducted between 2006 and 2007 at a university hospital in France. Data on individual patient history were obtained on the number of prior abdominal surgeries, the indications for surgery, abdominal cavity access, and type of incision. The primary study outcome was the presence of intra-abdominal adhesions. Over 60% (637/1000) of the laparoscopic procedures were performed in patients with a history of 1 or more abdominal surgery; 35% of these cases (350/1000) had only 1 prior abdominal surgery. The presence of intraoperative adhesions were noted in 21.1% (211/1000) of the cases; 28% (59/211) of these involved bowel loops. There was a significant increase in the rate of intestinal adhesions with increasing number of prior abdominal surgeries (1 [6.29%], 2 [8.29%], 3 [16.9%], and >3 [74%]; P < 0.001). The rate of intestinal adhesions was significantly higher among patients with a history of midline incision compared with the other incisions (P < 0.012). These findings indicate that evaluation of the risk of adhesion formation requires extensive preoperative knowledge of prior surgery. Adhesion formation does not appear to be influenced by the prior indication for surgery.