nach oben

Erschienen in:

01.03.2014 | Review Article

Adhesions after abdominal surgery: a systematic review of the incidence, distribution and severity

verfasst von: Koji Okabayashi, Hutan Ashrafian, Emmanouil Zacharakis, Hirotoshi Hasegawa, Yuko Kitagawa, Thanos Athanasiou, Ara Darzi

Erschienen in: Surgery Today | Ausgabe 3/2014

Einloggen, um Zugang zu erhalten

Abstract

Abdominal adhesions are associated with increased postoperative complications, cost and workload. We performed a systematic review with statistical pooling to estimate the formation rate, distribution and severity of postoperative adhesions in patients undergoing abdominal surgery. A literature search was carried out for all articles reporting on the incidence, distribution and severity of adhesions between January 1990 and July 2011. Twenty-five articles fulfilled the inclusion criteria. The weighted mean formation rate of adhesions after abdominal surgery was 54 % (95 % confidence interval [CI] 40–68 %), and was 66 % (95 % CI 38–94 %) after gastrointestinal surgery, 51 % (95 % CI 40–63 %) after obstetric and gynaecological surgery and 22 % (95 % CI 7–38 %) after urological surgery. The mean overall severity score was 1.11 ± 0.98 according to the Operative Laparoscopy Study Group classification. Laparoscopic surgery reduced the adhesion formation rate by 25 % and decreased the adhesion severity score (laparoscopic; 0.36 ± 0.69 vs. open; 2.14 ± 0.84) for gastrointestinal surgery. Our results demonstrate that the incidence and severity of abdominal adhesions varies between surgical specialties and procedures. An increased awareness of adhesions can help in identifying the underlying mechanisms of adhesion formation and novel therapeutic approaches, while also improving the surgical consent process.

Nur mit Berechtigung zugänglich

Menzies D, Ellis H. Intestinal obstruction from adhesions—how big is the problem? Ann Roy Coll Surg Engl. 1990;72:60–3.

Holmdahl L. The role of fibrinolysis in adhesion formation. Eur J Surg Suppl Acta Chir Suppl 1997;24–31.

Holmdahl L, Eriksson E, Eriksson BI, Risberg B. Depression of peritoneal fibrinolysis during operation is a local response to trauma. Surgery. 1998;123:539–44.PubMedCrossRef

Swank DJ, Jeekel H. Laparoscopic adhesiolysis in patients with chronic abdominal pain. Curr Opin Obstet Gynecol. 2004;16:313–8.PubMedCrossRef

Menzies D. Peritoneal adhesions. Incidence, cause, and prevention. Surg Ann. 1992;24(Pt 1):27–45.

Hershlag A, Diamond MP, DeCherney AH. Adhesiolysis. Clin Obstet Gynecol. 1991;34:395–402.PubMedCrossRef

Van Der Krabben AA, Dijkstra FR, Nieuwenhuijzen M, Reijnen MM, Schaapveld M, Van Goor H. Morbidity and mortality of inadvertent enterotomy during adhesiotomy. Br J Surg. 2000;87:467–71.CrossRef

Menzies D, Parker M, Hoare R, Knight A. Small bowel obstruction due to postoperative adhesions: treatment patterns and associated costs in 110 hospital admissions. Ann Roy Coll Surg Engl. 2001;83:40–6.

Prichayudh S, Sriussadaporn S, Samorn P, Pak-Art R, Sriussadaporn S, Kritayakirana K, et al. Management of open abdomen with an absorbable mesh closure. Surg Today. 2011;41:72–8.PubMedCrossRef

10.

Ray NF, Denton WG, Thamer M, Henderson SC, Perry S. Abdominal adhesiolysis: inpatient care and expenditures in the United States in 1994. J Am Coll Surg. 1998;186:1–9.PubMedCrossRef

11.

Schreinemacher MH, ten Broek RP, Bakkum EA, van Goor H, Bouvy ND. Adhesion awareness: a national survey of surgeons. World J Surg. 2010;34:2805–12.PubMedCentralPubMedCrossRef

12.

Rajab TK, Wallwiener M, Talukdar S, Kraemer B. Adhesion-related complications are common, but rarely discussed in preoperative consent: a multicenter study. World J Surg. 2009;33:748–50.PubMedCrossRef

13.

Stang A. Critical evaluation of the Newcastle–Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–5.PubMedCrossRef

14.

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.PubMedCentralPubMedCrossRef

15.

Blumenfeld YJ, Caughey AB, El-Sayed YY, Daniels K, Lyell DJ. Single-versus double-layer hysterectomy closure at primary caesarean delivery and bladder adhesions. BJOG. 2010;117:690–4.PubMedCrossRef

16.

Mais V, Ajossa S, Piras B, Guerriero S, Marongiu D, Melis GB. Prevention of de-novo adhesion formation after laparoscopic myomectomy: a randomized trial to evaluate the effectiveness of an oxidized regenerated cellulose absorbable barrier. Hum Reprod. 1995;10:3133–5.PubMed

17.

Becker JM, Dayton MT, Fazio VW, Beck DE, Stryker SJ, Wexner SD, et al. Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomized, double-blind multicenter study. J Am Coll Surg. 1996;183:297–306.PubMed

18.

Ugur M, Turan C, Mungan T, Aydogdu T, Sahin Y, Gokmen O. Laparoscopy for adhesion prevention following myomectomy. Int J Gynaecol Obstet. 1996;53:145–9.PubMedCrossRef

19.

Assaf A. Adhesions after laparoscopic myomectomy: effect of the technique used. Gynaecol Endosc. 1999;8:225–9.CrossRef

20.

Polymeneas G, Theodosopoulos T, Stamatiadis A, Kourias E. A comparative study of postoperative adhesion formation after laparoscopic vs open cholecystectomy. Surg Endosc. 2001;15:41–3.PubMedCrossRef

21.

Pattaras JG, Moore RG, Landman J, Clayman RV, Janetschek G, McDougall EM, et al. Incidence of postoperative adhesion formation after transperitoneal genitourinary laparoscopic surgery. Urology. 2002;59:37–41.PubMedCrossRef

22.

Vrijland WW, Tseng LN, Eijkman HJ, Hop WC, Jakimowicz JJ, Leguit P, et al. Fewer intraperitoneal adhesions with use of hyaluronic acid–carboxymethylcellulose membrane: a randomized clinical trial. Ann Surg. 2002;235:193–9.PubMedCrossRef

23.

Mettler L, Audebert A, Lehmann-Willenbrock E, Schive K, Jacobs VR. Prospective clinical trial of SprayGel as a barrier to adhesion formation: an interim analysis. J Am Assoc Gynecol Laparosc. 2003;10:339–44.PubMedCrossRef

24.

Tang CL, Seow-Choen F, Fook-Chong S, Eu KW. Bioresorbable adhesion barrier facilitates early closure of the defunctioning ileostomy after rectal excision: a prospective, randomized trial. Dis Colon Rectum. 2003;46:1200–7.PubMedCrossRef

25.

Swank DJ, Hop WC, Jeekel J. Reduction, regrowth, and de novo formation of abdominal adhesions after laparoscopic adhesiolysis: a prospective analysis. Dig Surg. 2004;21:66–71.PubMedCrossRef

26.

Cohen Z, Senagore AJ, Dayton MT, Koruda MJ, Beck DE, Wolff BG, et al. Prevention of postoperative abdominal adhesions by a novel, glycerol/sodium hyaluronate/carboxymethylcellulose-based bioresorbable membrane: a prospective, randomized, evaluator-blinded multicenter study. Dis Colon Rectum. 2005;48:1130–9.PubMedCrossRef

27.

Kusunoki M, Ikeuchi H, Yanagi H, Noda M, Tonouchi H, Mohri Y, et al. Bioresorbable hyaluronate-carboxymethylcellulose membrane (Seprafilm) in surgery for rectal carcinoma: a prospective randomized clinical trial. Surg Today. 2005;35:940–5.PubMedCrossRef

28.

Takeuchi H, Kitade M, Kikuchi I, Shimanuki H, Kumakiri J, Kinoshita K. Adhesion–prevention effects of fibrin sealants after laparoscopic myomectomy as determined by second-look laparoscopy: a prospective, randomized, controlled study. J Reprod Med. 2005;50:571–7.PubMed

29.

Tsuji S, Takahashi K, Yomo H, Fujiwara M, Kita N, Takebayashi K, et al. Effectiveness of antiadhesion barriers in preventing adhesion after myomectomy in patients with uterine leiomyoma. Eur J Obstet Gynecol Reprod Biol. 2005;123:244–8.PubMedCrossRef

30.

Zareian Z, Zareian P. Non-closure versus closure of peritoneum during cesarean section: a randomized study. Eur J Obstet Gynecol Reprod Biol. 2006;128:267–9.PubMedCrossRef

31.

Hamel KJ. Incidence of adhesions at repeat cesarean delivery. Am J Obstet Gynecol. 2007;196:e31–2.PubMedCrossRef

32.

Mettler L, Hucke J, Bojahr B, Tinneberg HR, Leyland N, Avelar R. A safety and efficacy study of a resorbable hydrogel for reduction of post-operative adhesions following myomectomy. Hum Reprod. 2008;23:1093–100.PubMedCrossRef

33.

Sileri P, Sthory R, McVeigh E, Child T, Cunningham C, Mortensen NJ, et al. Adhesions are common and costly after open pouch surgery. J Gastrointest Surg. 2008;12:1239–45.PubMedCrossRef

34.

Fatusic Z, Hudic I. Incidence of post-operative adhesions following Misgav Ladach caesarean section—a comparative study. J Matern Fetal Neonat Med. 2009;22:157–60.CrossRef

35.

Indar AA, Efron JE, Young-Fadok TM. Laparoscopic ileal pouch-anal anastomosis reduces abdominal and pelvic adhesions. Surg Endosc. 2009;23:174–7.PubMedCrossRef

36.

Tulandi T, Agdi M, Zarei A, Miner L, Sikirica V. Adhesion development and morbidity after repeat cesarean delivery. Am J Obstet Gynecol 2009;201:56e51–56.

37.

Myers SA, Bennett TL. Incidence of significant adhesions at repeat cesarean section and the relationship to method of prior peritoneal closure. J Reprod Med. 2005;50:659–62.PubMed

38.

Tinelli A, Malvasi A, Guido M, Tsin DA, Hudelist G, Hurst B, et al. Adhesion formation after intracapsular myomectomy with or without adhesion barrier. Fertil Steril. 2011;95:1780–5.PubMedCrossRef

39.

Chapa HO, Venegas G, Vanduyne CP, Antonetti AG, Sandate JP, Silver L. Peritoneal adhesion prevention at cesarean section: an analysis of the effectiveness of an absorbable adhesion barrier. J Reprod Med. 2011;56:103–9.PubMed

40.

Operative Laparoscopy Study Group. Postoperative adhesion development after operative laparoscopy: evaluation at early second-look procedures. Fertil Steril. 1991;55:700–4.

41.

Tang CL, Jayne DG, Seow-Choen F, Ng YY, Eu KW, Mustapha N. A randomized controlled trial of 0.5% ferric hyaluronate gel (Intergel) in the prevention of adhesions following abdominal surgery. Ann Surg. 2006;243:449–55.PubMedCrossRef

42.

The American Fertility Society classifications of Adnexal Adhesions. Distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, Mullerian anomalies and intrauterine adhesions. Fertil Steril. 1988;49:944–55.

43.

Ellis H, Moran BJ, Thompson JN, Parker MC, Wilson MS, Menzies D, et al. Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet. 1999;353:1476–80.PubMedCrossRef

44.

Weibel MA, Majno G. Peritoneal adhesions and their relation to abdominal surgery. A postmortem study. Am J Surg. 1973;126:345–53.PubMedCrossRef

45.

Monk BJ, Berman ML, Montz FJ. Adhesions after extensive gynecologic surgery: clinical significance, etiology, and prevention. Am J Obstet Gynecol. 1994;170:1396–403.PubMedCrossRef

46.

Dijkstra FR, Nieuwenhuijzen M, Reijnen MM, van Goor H. Recent clinical developments in pathophysiology, epidemiology, diagnosis and treatment of intra-abdominal adhesions. Scand J Gastroenterol Suppl 2000;52–59.

47.

Demco L. Pain mapping of adhesions. J Am Assoc Gynecol Laparosc. 2004;11:181–3.PubMedCrossRef

48.

Herrick SE, Mutsaers SE, Ozua P, Sulaiman H, Omer A, Boulos P, et al. Human peritoneal adhesions are highly cellular, innervated, and vascularized. J Pathol. 2000;192:67–72.PubMedCrossRef

49.

Sulaiman H, Gabella G, Davis MC, Mutsaers SE, Boulos P, Laurent GJ, et al. Presence and distribution of sensory nerve fibers in human peritoneal adhesions. Ann Surg. 2001;234:256–61.PubMedCrossRef

50.

Gutt CN, Oniu T, Schemmer P, Mehrabi A, Buchler MW. Fewer adhesions induced by laparoscopic surgery? Surg Endosc. 2004;18:898–906.PubMedCrossRef

51.

Molinas CR, Campo R, Elkelani OA, Binda MM, Carmeliet P, Koninckx PR. Role of hypoxia inducible factors 1alpha and 2alpha in basal adhesion formation and in carbon dioxide pneumoperitoneum-enhanced adhesion formation after laparoscopic surgery in transgenic mice. Fertil Steril. 2003;80(Suppl 2):795–802.PubMedCrossRef

52.

Molinas CR, Mynbaev O, Pauwels A, Novak P, Koninckx PR. Peritoneal mesothelial hypoxia during pneumoperitoneum is a cofactor in adhesion formation in a laparoscopic mouse model. Fertil Steril. 2001;76:560–7.PubMedCrossRef

53.

Keck JO, Collopy BT, Ryan PJ, Fink R, Mackay JR, Woods RJ. Reversal of Hartmann’s procedure: effect of timing and technique on ease and safety. Dis Colon Rectum. 1994;37:243–8.PubMedCrossRef

54.

Ahmad G, Duffy JM, Farquhar C, Vail A, Vandekerckhove P, Watson A et al. Barrier agents for adhesion prevention after gynaecological surgery. Cochrane Database Syst Rev. 2008;CD000475.

55.

Kumar S, Wong PF, Leaper DJ. Intra-peritoneal prophylactic agents for preventing adhesions and adhesive intestinal obstruction after non-gynaecological abdominal surgery. Cochrane Database Syst Rev. 2009;CD005080.

56.

Dwivedi AJ, Kuwajerwala NK, Silva YJ, Tennenberg SD. Effects of surgical gloves on postoperative peritoneal adhesions and cytokine expression in a rat model. Am J Surg. 2004;188:491–4.PubMedCrossRef

57.

Numanoglu V, Cihan A, Salman B, Ucan BH, Cakmak GK, Cesur A, et al. Comparison between powdered gloves, powder-free gloves and hyaluronate/carboxymethylcellulose membrane on adhesion formation in a rat caecal serosal abrasion model. Asian J Surg/Asian Surg Assoc. 2007;30:96–101.CrossRef

58.

van den Tol MP, Haverlag R, van Rossen ME, Bonthuis F, Marquet RL, Jeekel J. Glove powder promotes adhesion formation and facilitates tumour cell adhesion and growth. Br J Surg. 2001;88:1258–63.PubMedCrossRef

59.

Ordonez JL, Dominguez J, Evrard V, Koninckx PR. The effect of training and duration of surgery on adhesion formation in the rabbit model. Hum Reprod. 1997;12:2654–7.PubMedCrossRef

60.

van Goor H, Bom VJ, van der Meer J, Sluiter WJ, Bleichrodt RP. Coagulation and fibrinolytic responses of human peritoneal fluid and plasma to bacterial peritonitis. Br J Surg. 1996;83:1133–5.PubMedCrossRef

61.

Hockel M, Ott S, Siemann U, Kissel T. Prevention of peritoneal adhesions in the rat with sustained intraperitoneal dexamethasone delivered by a novel therapeutic system. Ann Chir Gynaecol. 1987;76:306–13.PubMed

62.

Kucukozkan T, Ersoy B, Uygur D, Gundogdu C. Prevention of adhesions by sodium chromoglycate, dexamethasone, saline and aprotinin after pelvic surgery. ANZ J Surg. 2004;74:1111–5.PubMedCrossRef

63.

Guvenal T, Cetin A, Ozdemir H, Yanar O, Kaya T. Prevention of postoperative adhesion formation in rat uterine horn model by nimesulide: a selective COX-2 inhibitor. Hum Reprod. 2001;16:1732–5.PubMedCrossRef

64.

De Leon FD, Toledo AA, Sanfilippo JS, Yussman MA. The prevention of adhesion formation by nonsteroidal antiinflammatory drugs: an animal study comparing ibuprofen and indomethacin. Fertil Steril. 1984;41:639–42.PubMed

65.

Nishimura K, Nakamura RM, diZerega GS. Ibuprofen inhibition of postsurgical adhesion formation: a time and dose response biochemical evaluation in rabbits. J Surg Res. 1984;36:115–24.PubMedCrossRef

66.

Liu Y, Li H, Shu XZ, Gray SD, Prestwich GD. Crosslinked hyaluronan hydrogels containing mitomycin C reduce postoperative abdominal adhesions. Fertil Steril. 2005;83(Suppl 1):1275–83.PubMedCrossRef

67.

Cubukcu A, Alponat A, Gonullu NN, Ozkan S, Ercin C. An experimental study evaluating the effect of mitomycin C on the prevention of postoperative intraabdominal adhesions. J Surg Res. 2001;96:163–6.PubMedCrossRef

68.

Brenner B. Haemostatic changes in pregnancy. Thromb Res. 2004;114:409–14.PubMedCrossRef

69.

Holmes VA, Wallace JM. Haemostasis in normal pregnancy: a balancing act? Biochem Soc Trans. 2005;33:428–32.PubMedCrossRef

70.

Egger M, Schneider M, Davey Smith G. Spurious precision? Meta-analysis of observational studies. BMJ. 1998;316:140–4.PubMedCrossRef

Titel: Adhesions after abdominal surgery: a systematic review of the incidence, distribution and severity
verfasst von: Koji Okabayashi
Hutan Ashrafian
Emmanouil Zacharakis
Hirotoshi Hasegawa
Yuko Kitagawa
Thanos Athanasiou
Ara Darzi
Publikationsdatum: 01.03.2014
Verlag: Springer Japan
Erschienen in: Surgery Today / Ausgabe 3/2014
Print ISSN: 0941-1291
Elektronische ISSN: 1436-2813
DOI: https://doi.org/10.1007/s00595-013-0591-8

Leitlinien kompakt für die Allgemeinmedizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Facharzt-Training Allgemeinmedizin

Die ideale Vorbereitung zur anstehenden Prüfung mit den ersten 24 von 100 klinischen Fallbeispielen verschiedener Themenfelder

Mehr erfahren

Neu im Fachgebiet Allgemeinmedizin

23.04.2024 | Prävention und Rehabilitation in der Kardiologie | Nachrichten

Update Allgemeinmedizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Adhesions after abdominal surgery: a systematic review of the incidence, distribution and severity

Abstract

Leitlinien kompakt für die Allgemeinmedizin

Facharzt-Training Allgemeinmedizin

Neu im Fachgebiet Allgemeinmedizin

Europäische Ernährungsgewohnheiten: Das sind die häufigsten Fehler

Ärztliche Empathie hilft gegen Rückenschmerzen

Demenzkranke durch Antipsychotika vielfach gefährdet

Parkinson-Therapie im Wandel – aktuelle Leitlinie im Fokus

Update Allgemeinmedizin

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 3/2014

Gender differences in prognosis after esophagectomy for esophageal cancer

Hand-assisted laparoscopic subtotal colectomy with cecorectal anastomosis for chronic idiopathic colonic pseudo-obstruction: report of a case

Treatment strategies for gastric cancer patients with peritoneal metastasis

Risk factors for anastomotic leakage and favorable antimicrobial treatment as empirical therapy for intra-abdominal infection in patients undergoing colorectal surgery

A comprehensive treatment approach is necessary for the closure of open window thoracostomy: an institutional review of 35 cases

Surgical treatment of neuroblastoma: twenty-three years of experience at a single institution

Leitlinien kompakt für die Allgemeinmedizin

Facharzt-Training Allgemeinmedizin

Neu im Fachgebiet Allgemeinmedizin

Europäische Ernährungsgewohnheiten: Das sind die häufigsten Fehler

Ärztliche Empathie hilft gegen Rückenschmerzen

Demenzkranke durch Antipsychotika vielfach gefährdet

Parkinson-Therapie im Wandel – aktuelle Leitlinie im Fokus

Update Allgemeinmedizin