Morbidity and mortality of inadvertent enterotomy during adhesiotomy

Krabben, A. A. van der; Dijkstra, Frederika; Nieuwenhuijzen, Marieke E. van de; Reijnen, Michel M.P.J.; Schaapveld, Michael; Goor, Harry van

doi:10.1046/j.1365-2168.2000.01394.x

Cited by 365 publications

(245 citation statements)

References 20 publications

Supporting

Mentioning

223

Contrasting

Unclassified

Order By: Relevance

“…Yet, perhaps, it is precisely this group of patients who most require radical and complete surgery, not only to correct the resultant anatomical abnormalities created by the adhesions, but also to identify underlying pathology, such as cul de sac endometriosis, which may otherwise fail to be identified by incomplete dissection. While other authors have suggested that laparoscopic adhesiolysis is associated with very high rates of bowel injury of up to 25%, and that this should be a reason for reluctance to perform the operation [8,16], there was no bowel injury in the current series, suggesting in line with other series [17] that high complication rates are not inevitable. All of the patients in our series had postoperative flotation of the pelvic and abdominal organs, some with heparinised saline and most with 4% icodextrin (Adept, Shire).…”

Section: Discussionsupporting

confidence: 76%

Long-term follow-up of pain and quality-of-life scores after laparoscopic adhesiolysis

2004

View full text Add to dashboard Cite

There is increasing evidence that laparoscopic adhesiolysis improves chronic pelvic pain. We performed a long-term review of women after laparoscopic adhesiolysis over the past 4 years. Patients were excluded from the study if they had additional pathology such as endometriosis or required additional procedures other than adhesiolysis. Umbilical insertion of Verress' needle and primary trocar was used except when the patient had had a previous midline laparotomy, in which case Palmer's point was used for entry. Adhesions were divided using Metzenbaum scissors with haemostasis using suction irrigation achieved with a Surgiflex R Wave suction irrigation system with BICAP bipolar diathermy probe (ACMI , USA). Hydroflotation with heparinised saline or 4% icodextrin was used to reduce adhesion recurrence. Patients were sent a postal questionnaire and contacted by telephone. Visual analogue scales were used to record pain scores for dysmenorrhoea (in those women who still had a uterus), dyspareunia, dyschezia and chronic daily pain. An EQ-5D questionnaire was also enclosed to assess quality of life. One hundred and forty-three procedures were identified between September 1998 and July 2002. Having excluded those with additional pathology that required treatment, 90 were eligible for the study. Seventy-six replies were obtained; seven patients had moved away. Sixty-nine replies were analysed. Fifty-one (74%) reported some improvement in their symptoms [12 (17%) pain completely gone, 26 (38%) greatly improved, 13 (19%) a little better]. Patients still had significant pain [scores out of 100 for dysmenorrhoea (45), dyspareunia (28), dyschezia (28) and daily pain (29)]. Overall, quality of life was still lower than national averages (self-rated health status mean =67.0 vs. 82.34, P< 0.05, weighted health state index =0.67 vs. 0.85, P< 0.05), except in the good responders (pain gone or greatly improved, for whom quality of life returned to normal). There was no difference in pain scores, response and quality of life between women who had had their surgery more than 24 months earlier and those who had had surgery more recently. We have found a good response to adhesiolysis, which is comparable with other studies. A good response is associated with a normal quality of life and appears to be long standing.

show abstract

Section: Discussionsupporting

confidence: 76%

Long-term follow-up of pain and quality-of-life scores after laparoscopic adhesiolysis

2004

View full text Add to dashboard Cite

show abstract

“…Indeed, in the current study, accidental full-thickness enterotomy occurred in six patients (11%) despite the presence of an experienced laparoscopic surgeon. However, this still compares favorably with the 19% rate for inadvertent enterotomies during 270 relaparotomies in open surgery, as reported by van der Krabben et al [20]. The laparoscopic technique in itself should thus not be regarded as a risk factor for iatrogenic bowel injury.…”

Section: Discussionmentioning

confidence: 63%

Laparoscopic parastomal hernia repair is feasible and safe: early results of a prospective clinical study including 55 consecutive patients

Hansson

Hingh

Bleichrodt³

2007

Surg Endosc

View full text Add to dashboard Cite

Background: Parastomal herniation is a common complication, and its operative treatment is notoriously difficult. Recently, the authors have described a laparoscopic technique for closure and reinforcement of the hernia with a hand-made ''funnel-shaped'' Gore-Tex Dual Mesh. Potentially this technique combines the advantages of a mesh repair with those of minimal invasive surgery. Methods: In 2002, a multicenter trial of this new technique was started in The Netherlands. To date, 55 consecutive patients (27 men; median age, 63 years) with a symptomatic primary (n = 45) or recurrent (n = 10) parastomal hernia have undergone elective surgery using this technique. The demographic, perioperative, and early follow-up data prospectively collected for these patients are presented in this report. Results: Of the 55 procedures, 47 (85.5%) could be completed laparoscopically (median operation time, 120 min). Conversion to laparotomy was indicated because of dense adhesions prohibiting safe dissection (n = 4) or bowel injury (n = 4). No in-hospital mortality occurred. Postoperative recovery was uneventful for 47 patients (85%), who had a median hospital stay of 4 days. Surgical and nonsurgical complications occurred, respectively, for four patients each (7.2%). Full-thickness enterotomy appeared to be the most troublesome complication. After 6 weeks, when all the patients were reexamined, one recurrence was noted. Conclusion: Maximal efforts should be undertaken to prevent perioperative full-thickness enterotomy. Because this was achieved for the vast majority of patients, it is concluded that laparoscopic parastomal hernia repair is feasible and safe. Although a longer follow-up period is needed for definitive conclusions to be drawn regarding the recurrence rate, early follow-up evaluation shows very promising results.

show abstract

“…Further, it is known that in reoperations, there is increased risk of bleeding and injury of adjacent organs (20). The secondary problems of intraabdominal adhesions formed after laparotomy may cause to economical costs (17,18). This study determined that the control group irrigated with SF showed more significant adhesion scores than the ID and HA groups.…”

Section: Discussionmentioning

confidence: 82%

“…Some of these problems may entail re-operation. It was indicated that abdominal adhesions formed after secondary laparotomy extended the laparoscopy, complicated the exploration and increased the possibility of iatrogenic intestinal diseases (17,18). It was reported that, in general surgery, 1% of all attempts and 3% of laparotomies are caused by peritoneal adhesions (19).…”

Section: Discussionmentioning

confidence: 99%

Comparison of 4% icodextrin and auto-crosslinked hyaluronic acid gel in terms of efficacy and cost effectivity in preventing postoperative abdominal adhesions

Baskonus¹,

Maralcan²,

Gökalp³

et al. 2013

Gaziantep Med J

View full text Add to dashboard Cite

This experimental study was designed to compare the effects and costs of 4% icodextrin and hyaluronic acid in intraabdominal adhesion formation in rats. This study included 30 healthy Wistar albino rats, each weighing 250-300 gr. Following cecal-ileal abrasion to rats in each group, the following treatments were applied: Group 1 (control, n:10) 5 ml saline irrigation; Group 2 (n:10) 5 ml 4% icodextrin solution; Group 3 (n:10) 3 ml auto-crosslinked hyaluronic acid gel. After 14 days, following a second operation, adhesion intensity scoring, histopathological assessment (inflammation, fibrosis) and costs were compared between groups. The lowest postoperative adhesion intensity score was found in the group 3 and the highest score was found in the group 1 (p=0.028). Group 3 had a non-significantly lower adhesion intensity score than group 2 (p>0.05). In terms of inflammation and fibrosis, group 2 had the lowest score, but there were no significant differences between all the groups (p>0.05). In terms of cost, 4% icodextrin is less expensive than hyaluronic acid. The results demonstrated that both hyaluronic acid and 4% icodextrin are similarly effective in reducing postoperative intraabdominal adhesions. In addition, 4% icodextrin is more cost-effective, which can be an advantage for clinical studies.

show abstract

Morbidity and mortality of inadvertent enterotomy during adhesiotomy

Abstract: The incidence of inadvertent enterotomy during reoperation is high. This adhesion-related complication has an impact on postoperative morbidity

Cited by 365 publications

References 20 publications

Long-term follow-up of pain and quality-of-life scores after laparoscopic adhesiolysis

Long-term follow-up of pain and quality-of-life scores after laparoscopic adhesiolysis

Laparoscopic parastomal hernia repair is feasible and safe: early results of a prospective clinical study including 55 consecutive patients

Comparison of 4% icodextrin and auto-crosslinked hyaluronic acid gel in terms of efficacy and cost effectivity in preventing postoperative abdominal adhesions

Contact Info

Product

Resources

About