Laparoscopy Compared With Laparotomy as a Risk Factor for Intra-abdominal Adhesion Formation [ID 2683454

Abstract

INTRODUCTION: The objective of this study is to compare the incidence and severity of abdominal and pelvic adhesions after laparoscopy versus laparotomy. METHODS: All patients undergoing laparoscopic surgery with study staff were included in this IRB-approved study. Postoperatively, surgeons filled out data collection forms to capture pertinent details. Patients with a history of only laparoscopy or only laparotomy were included, whereas those with known past inflammatory events, no prior surgeries, or a combination of laparoscopic and open procedures were excluded. RESULTS: Seventy-six laparoscopy-only and 83 laparotomy-only patients were included in this cohort. Adhesions were noted in 31 laparoscopy patients (40.8%) versus 74 laparotomy patients (89.2%; P<.001). Filmy adhesions were noted in 22 laparoscopy patients (28.9%) versus 37 laparotomy patients (44.6%), without statistical significance (P=.06098). Higher-grade adhesions were significantly more prominent in the laparotomy group. Laparotomy group had significantly more dense adhesions (55.4% versus 11.8%; P<.001) and cohesive adhesions with attached surfaces (32.5% versus 10.5%; P=.001614). By location, the laparotomy group had significantly more periumbilical adhesions (34.9% versus 3.9%; P<.001). Adhesiolysis time was shorter in laparoscopy (3 versus 10 minutes; P=.008439). CONCLUSION: Our data demonstrate that not only does laparotomy present a greater risk for adhesion formation than laparoscopy, but they are more likely to be present in the periumbilical area and the quality of those adhesions are significantly more likely to be dense and/or cohesive in nature, subjecting patients to more risk and requiring more surgical time to address.