Surgical adhesions among women undergoing laparoscopic gynecological surgery with or without adhesiolysis – prevalence, severity, and implications: retrospective cohort study at a University Hospital

Abstract

Objective: To find out the prevalence of adhesions, severity, and their relation to the current clinical scenario and to the type of previous surgery. Methods and Materials: A retrospective study of patients who already had different previous abdominopelvic surgery and subsequently underwent gynecological laparoscopic surgery for various indications. The patients’ clinical and operative notes were reviewed and analyzed. Results: There were 654 procedures performed. The most common indication for the laparoscopic surgery was secondary infertility 23.5%, followed by adnexal lesions 22.0% and primary infertility 19.6%. Intraoperative adhesions were found in 45.3%. Adhesions were deemed relevant to the clinical scenario in 21.3%. Patients who had a previous history of open (traditional) surgery were more likely to be found with adhesions in comparison with patients with history of laparoscopic surgery (odds ratio: 2.7, 95% confidence interval: 1.4–5.3, p = 0.0025). The presence of adhesions was found to be strongly associated with previous abdominopelvic surgery than non-abdominopelvic surgery (odds ratio: 4.3, p = 0.0078, 95% confidence interval: 1.5–12.5). The most common location of the adhesions was abdominal (36.1%), mixed abdominal and pelvic (35.1%), and pelvic adhesions (28.1%). Severe adhesions were found in 36.1%; 13.6% of converted laparoscopy to open surgery was due to adhesions. Cesarean sections were significantly associated with adhesions. Patients who had cesarean sections were more likely to have adhesions than those who had not (odds ratio: 5.7, 95% confidence interval: 3.8–8.6, p < 0.0001). Adhesiolysis was done without complications in 19.6% of patients with adhesions. Conclusion: Adhesions were prevalent in gynecological patients with previous abdominopelvic surgery. They were a significant contributor to the gynecological and reproductive issues. To minimize the risk of postoperative adhesions, laparoscopic approach should be encouraged instead of traditional surgery and rates of cesarean section should be reduced. Further high-quality studies are needed to establish conclusion and practical guidance toward the use of adhesion barriers.

Peritoneal Adhesion Findings during Laparoscopy

“…[ 5 19 ] Our finding also contrasts an observation from Ghana, in a study involving repeat cesarean section, which reported a prevalence of 38% adhesion formation rate among women who had undergone prior cesarean section. [ 7 ] A similar study from Jordan reports a prevalence of 45.3%,[ 9 ] which is lower than observed in our center. A much lower rate of 21.1% was observed by Dubuisson et al .…”

“…Most of these women have had prior abortions which is a recognized risk factor for secondary infertility due to tubal, endometrial or peritoneal disease. [ 5 9 19 20 ] Unsafe abortion is a recognized risk factor for pelvic infection, including adhesion formation and infertility. [ 21 ]…”

“…Previous studies have repeatedly implicated previous surgeries involving the peritoneal cavity as the major risk factor for adhesion formation,[ 4 5 6 7 8 9 ] with an increase in risk for procedure abandonment, conversion to laparotomy,[ 9 ] or other adverse outcomes. [ 4 5 7 ] Conclusions, however, differ on the primary surgical procedures, which portend the greatest risk or are associated with the most severe forms of peritoneal adhesions.…”

Intra-abdominal Adhesions among Patients Undergoing Repeat Caesarean Section in Department of Obstetrics and Gynaecology of a Tertiary Care Centre: A Descriptive Cross-sectional Study

“…The intra abdominal adhesions were present in 36.1% of the patients which was lower when compared to our study. 13 A study reported that 45.1% of patients with a history of CS showed evidence of pelvic adhesions during the ultrasonographic examination. 14 Our study had shown that the mean operating time was higher in severe adhesions than mild adhesions which was comparable to another similar study.…”

Recurrent Pouch Volvulus Following Ileoanal J-Pouch Anastomosis: A Case Report

“…Traditionally, IPAA procedures were performed in an open fashion; however, with advances in medical technology, a minimally invasive approach using laparoscopy is now preferred, which has made recovery time quicker and the likelihood of adhesions lower [ 17 , 18 ]. Adhesions are considered unfavourable as these can lead to a higher chance of postoperative complications; however, a recent paper by Dionigi et al [ 19 ] suggests that this decrease in adhesions through using laparoscopy, in fact, predisposes the pouch and its proximal small bowel to volvulus.…”