Adhesion-related readmissions after surgery for deep endometriosis with the use of icodextrin—long-term results

Abstract

Icodextrin (Adept®) has been shown to prevent postoperative adhesions in experimental and laparoscopic adhesiolysis surgery. However, the role of icodextrin in the prevention of adhesions in extensive gynecological surgery is unclear. The present study evaluated the effect of icodextrin on adhesion-related readmissions after extensive gynecological surgery. The hospital readmissions of 140 endometriosis patients operated on at Päijät-Häme Central Hospital in 2004-2008 with the use of icodextrin were retrospectively reviewed. The evaluation of readmissions focused on adhesion-related disorders and reoperations. If an abdominal or pelvic reoperation was performed, the extent of the adhesions was classified. The mean follow-up time was 6.53 years (range 0.21-9.83). After initial surgery, one patient (0.7 %) had adhesive small bowel obstruction. Another directly adhesion-related readmission occurred in two patients (1.4 %). The number of readmissions possibly related to adhesions was 3 (2.1 %). Abdominal or pelvic reoperation was performed on 54 patients (38.6 %): 4 in the open surgery group and 50 in the laparoscopic surgery group. The extent of the adhesions among the 54 reoperated patients was as follows: not mentioned in 16 patients, no adhesions in 14, mild in 18, moderate in 5, and severe in 1. There were two (3.7 %) bowel injuries (one enterotomy and one serosal lesion) in reoperations. The incidence of adhesion-related readmissions after the use of icodextrin is relatively low. This favorable result may be partly related to the laparoscopic technique. Despite the use of an anti-adhesion agent, in some patients, the extent of postoperative adhesions is severe.

Management, Prevention, and Sequelae of Adhesions in Women Undergoing Laparoscopic Gynecologic Surgery: A Systematic Review

“…retrospective cohort study, endometriosis resection with Adept placement resulted in an 11.2% incidence of moderate to severe de novo adhesions and a 33.3% incidence of mild de novo adhesions [28].…”

“…The most common reason for reoperation was cesarean section (35.8%) followed by reoperation for endometriosis (27.8%), hysterectomy (11.2%), adhesiolysis (7.4%), cholecystectomy (5.6%), appendectomy (3.7%), diagnostic laparoscopy (3.7%), myomectomy (1.9%), ileal resection (1.9%), and laparoscopic ileocecal resection (1.9%). Additionally, 2.1% of readmissions were thought to be caused by adhesions or small bowel obstructions [28].…”