Effect of previous surgery on abdominal opening time

Beck, David E.; Ferguson, Martha A.; Opelka, Frank G.; Fleshman, James W.; Gervaz, Pascal; Wexner, Steven D.

doi:10.1007/bf02236862

Cited by 129 publications

(100 citation statements)

References 7 publications

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“…The development of post-operative adhesion is known to increase the surgical time in subsequent surgeries, as a result of the need for adhesiolysis, the risk of intraoperative complications [24] and the possibility of conversion from laparoscopic procedure to laparotomy. [25] Although a history of abdominal surgery had been considered a contraindication for laparoscopic surgery in the early days of the procedure, improvements in technique and instrumentation have more recently permitted many laparoscopic procedures to be safely applied to such patients.…”

Section: Discussionmentioning

confidence: 99%

“…[25] Although a history of abdominal surgery had been considered a contraindication for laparoscopic surgery in the early days of the procedure, improvements in technique and instrumentation have more recently permitted many laparoscopic procedures to be safely applied to such patients. [24,[26][27][28][29] However, LLR remains a technically demanding procedure and the indications for and efficacy of repeat LLRs are still under discussion. Successful liver resection requires adequate adhesiolysis and mobilization of the involved liver area.…”

Section: Discussionmentioning

confidence: 99%

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Case report of the fourth laparoscopic liver resection and review of repeat laparoscopic resection for recurrent hepatocellular carcinoma in cirrhotic liver

Morise¹,

Isetani²,

Kawabe³

et al. 2016

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A 73-year-old woman with liver cirrhosis caused by hepatitis C virus (HCV) underwent treatment of three hepatocellular carcinomas (HCCs) in liver segment 4, following three previous laparoscopic liver resections (LLRs) over 73 months. Contrast-enhanced computed tomography showed three 0.5-1.2 cm HCCs deep within the portal territories of subsegments 4a and 4b. The patient underwent laparoscopic resection of 4a and 4b, with the preservation of the portal branch to 4c, after minimal adhesiolysis around segment 4. The operation lasted 284 min, there was 50 mL of intra-operative bleeding and her recovery was uneventful. She was well, had experienced no recurrence and was HCV-negative, after taking oral anti-HCV therapy, 21 months later. LLR is associated with fewer adhesions after surgery and requires less adhesiolysis, because the laparoscope and forceps can be used in the small spaces between adhesions. The present patient underwent four LLRs over 6 years without severe deterioration of liver functional reserve. LLR is a useful localized therapy, which can be performed repeatedly and may prolong the survival of patients with multicentric metachronous HCCs. Key words:Laparoscopic liver resection, repeat liver resection, hepatocellular carcinoma, liver cirrhosis, anatomical liver resection, subsegmentectomy ABSTRACT Article history:

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Case report of the fourth laparoscopic liver resection and review of repeat laparoscopic resection for recurrent hepatocellular carcinoma in cirrhotic liver

Morise¹,

Isetani²,

Kawabe³

et al. 2016

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show abstract

“…For patients undergoing subsequent surgery, adhesions pose an important complicating factor with adhesions from previous surgery significantly increasing operating time [38,39]. In addition, even in the hands of experienced surgeons, there is a 19% risk of inadvertent enterotomy at reoperative laparotomy [40] and a 10-25% risk of bowel injury in laparoscopic adhesiolysis [41].…”

Section: Adhesion-related Complicationsmentioning

confidence: 99%

“…Pre-existing adhesions significantly prolong the duration of surgery [38,39] and lead to considerable complications in an important percentage of patients. This is particularly the case in accidental intestinal enterotomy which is accompanied by an increased need for intensive care facilities, extended hospitalisation and increased ward costs [40,41].…”

Section: The Cost Of Adhesionsmentioning

confidence: 99%

Postoperative abdominal adhesions and their prevention in gynaecological surgery. Expert consensus position

DeWilde

Trew

2007

Gynecol Surg

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Adhesions are the most frequent complication of abdominopelvic surgery, yet many surgeons are still not aware of the extent of the problem and its serious consequences. While adhesions may cause few or no detrimental effects to patients, in a considerable proportion of cases there are major short-and long-term consequences, including small-bowel obstruction, infertility and chronic pelvic pain. Adhesions complicate future surgery with important associated morbidity and expense-and a considerable risk of mortality. Despite advances in surgical techniques in recent years, the burden of adhesion-related complications has not changed. Adhesions should now be considered the most common complication of abdominopelvic surgery. Adhesiolysis remains the main treatment, despite the fact that adhesions reform in most patients. Developments in adhesion-reduction strategies and new agents now offer a realistic possibility of reducing the risk of adhesions forming and can improve the outcomes for patients and the associated onward burden. This consensus position represents the collective views of 35 gynaecologists with a recognised interest in adhesions. The position is presented in two parts. The first part reviews the published literature on the extent of the problem of adhesions, and the second part considers the opportunities to reduce their incidence. It also provides collective proposals on the actions that European gynaecologists should take to avoid causing adhesions. Importantly it also advises that it is now time to inform patients of the risks associated with adhesion-related complications during the consent process. With increasing evidence to support the efficacy of adhesion-reduction agents to complement good surgical practice, all surgeons should act now to reduce adhesions and fulfil their duty of care to patients.

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“…[1,2] Adhesions can significantly alter spatial anatomy, resulting in obstruction and technically challenging surgeries in the future. [3,4] Adhesions account for 50 to 80% of mechanical small bowel obstruction (SBO). [5,6] Among SBO secondary to adhesions, it is estimated that 85% are caused by intra-abdominal surgery, 10% follow peritonitis, and 5% are due to an idiopathic or congenital etiology.…”

Section: Introductionmentioning

confidence: 99%

Manual physical therapy clears adhesive bowel obstruction and strictures in a patient with Crohn’s disease

Weinstock¹,

Pratt²,

Wurn³

et al. 2018

IJCR

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A woman with Crohn's disease with prior resection presented with a one-year history of persistent abdominal pain. The small bowel follow-through radiograph demonstrated the presence of two strictures in the small intestine due to adhesive scarring.Opting for conservative management, the patient underwent a specialized manual physical therapy regimen. Following treatment, the patient experienced significant decrease of abdominal pain and improved biomechanical function. Radiologic imaging revealed complete resolution of both strictures. Manual physical therapy may be a viable non-operative option to manage small bowel strictures or obstruction.

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Effect of previous surgery on abdominal opening time

Abstract: Previous surgery and the presence of adhesions add significant time to opening the abdomen.

Cited by 129 publications

References 7 publications

Case report of the fourth laparoscopic liver resection and review of repeat laparoscopic resection for recurrent hepatocellular carcinoma in cirrhotic liver

Case report of the fourth laparoscopic liver resection and review of repeat laparoscopic resection for recurrent hepatocellular carcinoma in cirrhotic liver

Postoperative abdominal adhesions and their prevention in gynaecological surgery. Expert consensus position

Manual physical therapy clears adhesive bowel obstruction and strictures in a patient with Crohn’s disease

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