Complications of Adhesion Formation After Abdominal and Pelvic Surgery

Paul S. Mueller, MD, MPH, FACP

Adhesions were implicated in 56% of postoperative small bowel obstructions.

Adhesion formation after abdominal and pelvic surgery can cause small bowel obstruction, female infertility, difficulties at reoperation, and chronic abdominal pain. To estimate the disease burden of these complications, investigators in the Netherlands conducted a systematic review and meta-analysis of 196 studies that involved 151,000 patients.

Overall incidence of postoperative small bowel obstruction from any cause at any time after surgery was 9%. In studies in which causes of postoperative small bowel obstruction were confirmed, adhesions were the most common cause (56%). Incidence of adhesive small bowel obstruction varied with previous surgery: pediatric surgery, 4.2%; lower gastrointestinal (GI) tract surgery, 3.2%; urological surgery, 1.5%; upper GI tract surgery, 1.2%; and abdominal wall surgery, 0.5%. Incidence of adhesions was lower after laparoscopic surgery (1.4%) than after open surgery (3.8%). In-hospital mortality was 2.5%. Incidence of inadvertent bowel injury during repeat abdominal surgery was 3.3% (5.8% in studies in which lysis of adhesions could be confirmed). Fertility was lower in women who had undergone colorectal surgery for inflammatory bowel disease than in women who had not had such surgery (odds ratio, 0.15). In patients with chronic postoperative pain, adhesions were identified as the most likely cause (57%).

Citation(s):

ten Broek RPG et al. Burden of adhesions in abdominal and pelvic surgery: Systematic review and met-analysis. BMJ 2013 Oct 3; 347:f5588.