Postoperative adhesions in the form of sheets of tissue or thick fibrous bands are the most common complications of abdominal or pelvic surgery. Although it’s a general procedure, patients often consult with specialists later on to address adhesion removal or repair, and it’s the original surgeons’ ignorance of those consultations that has led to a lack of awareness of adhesion-related complications.
Much research has used hospital readmission as a proxy for the effects of adhesions. However, the method fails to identify detailed information about different adhesive complications. Using a systematic review with meta-analyses
of 196 eligible trials, researchers from the Netherlands studied more specific effects of adhesion formation to formulate a valid estimate of the disease burden.
The researchers looked for the 4 most important postoperative adhesion formation complications, which are small bowel obstruction, difficulties at repeated abdominal surgery, female infertility, and chronic pain. They determined that small bowel obstruction from any cause after abdominal surgery was 9%, while the incidence of adhesive small bowel obstruction was 2%. In general, surgeons confirmed patients’ adhesions during an emergency reoperation.
In cases where the cause of small bowel obstruction could be determined, adhesions were the most common cause and accounted for 56% of obstructions, the authors found. The presence of adhesions in patients with previous surgery prolonged surgical time by an average of 15 minutes. When adhesiolysis was used, iatrogenic bowel injury occurred in 6% of patients and surgical time was prolonged.
In patients with inflammatory bowel disease who developed adhesions, the post-surgical pregnancy rate was 50%, compared to the 82% pregnancy rate in comparable patients who were treated medically. In addition, between 40% and 60% of patients who developed adhesions experienced chronic pain, and adhesions were the most likely cause.
The review provided a good overview of the disease burden of adhesions. The study authors said surgeons can use the information to improve informed consent, which is an important consideration since fewer than 10% of surgeons include information about the possibility of adhesion in their counseling. In light of the potential for a substantial negative effect on health and quality of life, addressing adhesions before surgery is important, the researchers concluded.