Adhesiolysis-Related Morbidity in Abdominal Surgery

Broek, Richard P. G. ten; Strik, Chema; Issa, Yama; Bleichrodt, Robert P.; Goor, Harry van

doi:10.1097/sla.0b013e31826f4969

Cited by 201 publications

(185 citation statements)

References 32 publications

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“…Some asymmetry, however, is due to high incidences derived from high quality studies designed to assess incidences of small bowel obstruction or enterotomy. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] That is, some smaller low quality studies reporting lower incidences were possibly not identified. Our sensitivity analyses, however, showed that our results were quite robust, so we do not expect that these smaller low quality studies would change our results.…”

Section: Strengths and Limitations Of Studymentioning

confidence: 99%

“…[4][5][6][7][8][9][10][11][12][13][14][15][16] In the SCAR studies, readmissions (defined by identification and diagnostic codes) were used as a proxy for the effect of adhesions. Incidence of adhesions will be difficult to confirm using these diagnostic codes.…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

“…Unlike other postoperative complications, such as wound infection or anastomotic leakage, the consequences of adhesion formation comprise a lifelong risk for various clinical entities. [1][2][3][4][5][6] Patients with adhesion related complications are often treated by specialists other than the surgeon who did the first operation. The first surgeon therefore remains unaware of the complication, which might explain the gross underestimation of adhesion related complications among surgeons and gynaecologists.…”

Section: Introductionmentioning

confidence: 99%

“…Adhesions may cause acute abdomen by bowel obstruction and female infertility, and patients may require reoperation. [5][6][7][8][9][10][11][12][13][14] Lysis of adhesions is associated with a prolonged operative time and an increased risk of intraoperative and postoperative complications. 5 14 Most of the epidemiological knowledge of adhesions has been derived from the extensive work of the Surgical and Clinical Adhesions Research (SCAR) Group.…”

Section: Introductionmentioning

confidence: 99%

“…5 14 Most of the epidemiological knowledge of adhesions has been derived from the extensive work of the Surgical and Clinical Adhesions Research (SCAR) Group. [4][5][6][7][8][9][10][11][12][13][14][15][16] They, however, defined readmissions as a proxy for the effect of adhesions, which lacks detailed information on the effect of different adhesive complications. Data on adhesion related complications are reported incidentally, and different outcome measures have been used.…”

Section: Introductionmentioning

confidence: 99%

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Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis

Broek

Issa

Santbrink

et al. 2013

BMJ

487

291

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Objective To estimate the disease burden of the most important complications of postoperative abdominal adhesions: small bowel obstruction, difficulties at reoperation, infertility, and chronic pain.Design Systematic review and meta-analyses.Data sources Searches of PubMed, Embase, and Central, from January 1990 to December 2012, without restrictions to publication status or language.Study selection All types of studies reporting on the incidence of adhesion related complications were considered.Data extraction and analysis The primary outcome was the incidence of adhesive small bowel obstruction in patients with a history of abdominal surgery. Secondary outcomes were the incidence of small bowel obstruction by any cause, difference in operative time, enterotomy during adhesiolysis, and pregnancy rate after abdominal surgery. Subgroup and sensitivity analyses were done to study the robustness of the results. A random effects model was used to account for heterogeneity between studies.Results We identified 196 eligible papers. Heterogeneity was considerable for almost all meta-analyses. The origin of heterogeneity could not be explained by study design, study quality, publication date, anatomical site of operation, or operative technique. The incidence of small bowel obstruction by any cause after abdominal surgery was 9% (95% confidence interval 7% to 10%; I 2 =99%). the incidence of adhesive small bowel obstruction was 2% (2% to 3%; I 2 =93%); presence of adhesions was generally confirmed by emergent reoperation. In patients with a known cause of small bowel obstruction, adhesions were the single most common cause (56%, 49% to 64%; I 2 =96%). Operative time was prolonged by 15 minutes (95% confidence interval 9.3 to 21.1 minutes; I 2 =85%) in patients with previous surgery. Use of adhesiolysis resulted in a 6% (4% to 8%; I 2 =89%) incidence of iatrogenic bowel injury. The pregnancy rate after colorectal surgery in patients with inflammatory bowel disease was 50% (37% to 63%; I 2 =94%), which was significantly lower than the pregnancy rate in medically treated patients (82%, 70% to 94%; I 2 =97%).Conclusions This review provides detailed and systematically analysed knowledge of the disease burden of adhesions. Complications of postoperative adhesion formation are frequent, have a large negative effect on patients' health, and increase workload in clinical practice. The quantitative effects should be interpreted with caution owing to large heterogeneity.

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Section: Strengths and Limitations Of Studymentioning

confidence: 99%

Section: Comparison With Other Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis

Broek

Issa

Santbrink

et al. 2013

BMJ

487

291

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Generation of mesothelial progenitor‐like cells from mouse‐induced pluripotent stem cells

Inagaki

Kokudo

et al. 2019

FEBS Letters

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Mesothelial cells, which cover the surface of visceral organs and serous cavities in mammals, play a crucial role in preventing adhesion. We previously reported that primary mesothelial progenitor cells (MPCs) can not only prevent postoperative adhesion but also promote liver regeneration after hepatectomy. Induced pluripotent stem cells (iPSCs) have the potential to be used for regenerative medicine. Here, we have established a differentiation protocol for mouse iPSC‐derived MPCs (miMPCs) via the exposure to defined factors, as well as purification using MPC‐specific cell surface antigens. Furthermore, the miMPCs had the ability to suppress postoperative adhesion and facilitate liver regeneration. This is the first report highlighting the generation of functional miMPCs, which may offer potential for de novo cell therapy.

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Biodegradable Zwitterionic Cream Gel for Effective Prevention of Postoperative Adhesion

Zhang

Yang

Wang

et al. 2020

Adv Funct Materials

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Postoperative peritoneal adhesions are frequent complications for almost any type of abdominal and pelvic surgery. This leads to numerous medical problems and a huge financial burden to the patients. Current anti‐adhesion strategies focus mostly on physical barriers including films and hydrogels. However, they can only alleviate or reduce adhesions to a certain level and their applying processes are far from ideal. This work reported the development of a biodegradable zwitterionic cream gel presenting a series of characters for an ideal anti‐adhesion material, including unique injectable yet malleable and self‐supporting properties, which enables an instant topical application, no curing, waiting, or suturing, no hemostasis requirement, protein/cell resistance, and biodegradability. The cream gel shows a major advancement in anti‐adhesion efficacy by completely and reliably preventing a primary and more severe recurrent adhesion in rat models.

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Adhesiolysis-Related Morbidity in Abdominal Surgery

Abstract: Adhesiolysis and inadvertent bowel injury have a large negative effect on the convalescence after abdominal surgery. The awareness of adhesion-related morbidity during reoperation and the prevention of postsurgical adhesion deserve priority in research and clinical practice.

Cited by 201 publications

References 32 publications

Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis

Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis

Generation of mesothelial progenitor‐like cells from mouse‐induced pluripotent stem cells

Biodegradable Zwitterionic Cream Gel for Effective Prevention of Postoperative Adhesion

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