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Hysterectomy pp 373-379 | Cite as

General Aspects and Their Handling: Adhesions

  • Andreas HackethalEmail author
  • Jörg Engel
  • Hans-Rudolf Tinneberg
  • Sebastian F. M. Häusler
Chapter
  • 705 Downloads

Abstract

Intraabdominal adhesions are the most frequent complication of abdominal surgery and may represent one of the greatest unsolved problems in medicine today. They severely diminish quality of life of many patients who are affected by bowel obstruction, infertility and chronic abdominal pain. Hence, adhesions and their consequences are associated with high morbidity, a considerable risk of mortality as well as an increasing burden of medicolegal claims and socioeconomic expenses. This chapter summarizes key steps in anticipating, diagnosing and treating intraabdominal adhesions. Additionally, strategies to reduce adhesions formation are summarized. Up to 90 % of previously operated patients may have adhesions, most are asymptomatic. There is no standard imaging modality available to safely identify or rule out adhesions. In patients with clinically expected intraabdominal adhesions, adequate surgical steps (patient consent, adjustment of abdominal entry as an example) should be followed. There is strong evidence to lyse potentially symptomatic adhesions, whereas adhesiolysis in asymptomatic patients may not have a benefit. Patients with an increased individual risk of adhesion formation could be treated with anti-adhesion products. Although some of these products proofed successfully to reduce adhesion formation in several clinical trials, their usage is limited due to financial considerations. Further, it is highly recommended to clarify the adhesion formation risk and related complications during written consent before every surgery.

Keywords

Intraabdominal adhesions Complications Fibrinolysis Prevention Anti-adhesion products Adhesion prevention 

References

  1. 1.
    Van Der Krabben AA, Dijkstra FR, Nieuwenhuijzen M, et al. Morbidity and mortality of inadvertent enterotomy during adhesiotomy. Br J Surg. 2000;87:467–71.CrossRefPubMedGoogle Scholar
  2. 2.
    Ellis H, Moran BJ, Thompson JN, et al. Adhesion-related readmissions after abdominal pelvic surgery: a retrospective cohort study. Lancet. 1999;353:1476–80.CrossRefPubMedGoogle Scholar
  3. 3.
    Mavros MN, Velmahos GC, Lee J, et al. Morbidity related to concomitant adhesions in abdominal surgery. J Surg Res. 2014;192:286–92.CrossRefPubMedGoogle Scholar
  4. 4.
    GS dZ. Contemporary adhesion prevention. Fertil Steril. 1994;61:219–35.CrossRefGoogle Scholar
  5. 5.
    Menzies D, Ellis H. Intestinal obstruction from adhesions: How big is the problem? Ann R Coll Surg Engl. 1990;72:60–3.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Operative Laparoscopy Study Group. Postoperative adhesion development after operative laparoscopy: evaluation at early second-look procedures. Fertil Steril. 1991;55:700–4.CrossRefGoogle Scholar
  7. 7.
    Monk BJ, Berman ML, Monitz FJ. Adhesions after extensive gynecologic surgery: clinical significance, etiology and prevention. Am J Obstet Gynecol. 1994;170:1396–403.CrossRefPubMedGoogle Scholar
  8. 8.
    Dembowski T. Über die Ursachen der peritonealen Adhäsionen nach chirurgischen Eingriffen mit Rücksicht auf die Frage des Ileus nach Laparotomien. Langenbecks Arch Chir. 1889;37:745.Google Scholar
  9. 9.
    Uhlmann C. Ueber das Auftreten peritonealer Adhäsionen nach Laparotomien, mit besonderer Berücksichtigung des Verhaätnisses zwischen trockener und feuchter Asepsis. Arch Gynecol Obstet. 1897;54:384–411.Google Scholar
  10. 10.
    Grund D. Neue Möglichkeiten zur Reduzierung von postoperativen Adhäsionen. Eine vergleichende tierexperimentelle Studie mit abriebarmen Bauchtüchern und Perfluorcarvon PF 5080. 2004, Promotion Charite – Universitätsmedizin Berlin.Google Scholar
  11. 11.
    Durron JJ. Postoperative intraperitoneal adhesion pathophysiology. Colorectal Dis. 2007;9(Suppl 2):14–24.CrossRefGoogle Scholar
  12. 12.
    DeWilde RL, Brölmann H, Koninckx PR, The Anti-Adhesions in Gynecology Expert Panel (ANGEL), et al. Prevention of adhesions in gynaecological surgery: the 2012 European field guideline. Gynecol Surg. 2012;9:365–8.CrossRefGoogle Scholar
  13. 13.
    Hindocha A, Beere L, Dias S, et al. Adhesion prevention agents for gynaecological surgery: an overview of Cochrane reviews. Cochrane Database Syst Rev. 2015;1:CD011254.PubMedGoogle Scholar
  14. 14.
    Brüggmann D, Tchartchian G, Wallwiener M, Münstedt K, Tinneberg H-R, Hackethal A. Intra-abdominal adhesions: definition, origin, significance in surgical practice, and treatment options. Dtsch Arztebl Int. 2010;107:769–75.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Liakakos T, Thomakos N, Fine PM, Dervenis C, Young RL. Peritoneal adhesions: etiology, pathophysiology, and clinical significance. Dig Surg. 2001;18:260–73.CrossRefPubMedGoogle Scholar
  16. 16.
    Robertson D, Lefebvre G, Leyland N, et al. Adhesion prevention in gynaecological surgery. J Obstet Gynaecol Can. 2010;32:598–608.CrossRefPubMedGoogle Scholar
  17. 17.
    Levrant SG, Bieber EJ, Barnes RB. Anterior abdominal wall adhesions after laparotomy or laparoscopy. J Am Assoc Gynecol Laparosc. 1997;4:353–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Sepilian V, Ku L, Wong H, et al. Prevalence of intraabdominal ahdesions in women with previous laparoscopy. JSLS. 2007;11:|41–4.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Hackethal A, Sick C, Brueggmann D, et al. Awareness and perception of intraabdominal adhesions and related consequences. Survey of gynaecologists in German hospitals. Eur J Obstet Gynecol Reprod Biol. 2010;150:180–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Trew G, Cooke I, Lower A, McVeigh E. Post-operative abdominal adhesions – awareness of UK gynaecologists – a survey of members of the Royal College of Obstetricians and Gynaecologists. Gynecol Surg. 2009;6:25–37.CrossRefGoogle Scholar
  21. 21.
    Wallwiener M, Koninckx PR, Hackethal A, for The Anti-Adhesions in Gynecology Expert Panel (ANGEL), et al. A European survey on awareness of post-surgical adhesions among gynaecological surgeons. Gynecol Surg. 2014;11:105–12.CrossRefPubMedGoogle Scholar
  22. 22.
    Lower AM, Hawthorn RJ, Ellis H, et al. The impact of adhesions on hospital readmissions over ten years after 8849 open gynaecological operations: an assessment from the Surgical and Clinical Adhesions Research Study. BJOG. 2000;107:855–62.CrossRefPubMedGoogle Scholar
  23. 23.
    Al-Sunaidi M, Tulandi T. Adhesion-related bowel obstruction after hysterectomy for benign conditions. Obstet Gynecol. 2006;108:1162–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Muffly TM, Ridgeway B, Abbott S, et al. Small bowel obstruction after hysterectomy to treat benign disease. J Minim Invasive Gynecol. 2012;19:615–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Zia S, Rafique M. Intra-operative domplications increase with successive number of cesarean sections: myth or fact? Obstet Gynecol Sci. 2014;57:187–92.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Özcan S, Karayalcin R, Kanat PM. Multiple repeat cesarean delivery is associated with increase maternal morbidity irrespective of placenta accreta. Eur Rev Med Pharmacol Sci. 2015;19:1959–63.PubMedGoogle Scholar
  27. 27.
    Bamigboye AA, Hofmeyr GJ. Closure versus non-closure of the peritoneum at caesarean section: short- and long-term outcomes. Cochrane Database Syst Rev. 2014;8:CD000163.Google Scholar
  28. 28.
    Aziz. Laparoscopic evaluation of female factors in infertility. J Coll Physicians Surg Pak. 2010;20:649–52.PubMedGoogle Scholar
  29. 29.
    Luijendijk RW, de Lange DC, Wauters CC, et al. Foreign material in postoperative adhesions. Ann Surg. 1996;223:242–8.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Duffy DM, GS dZ. Adhesion controversies: pelvic pain as a cause of adhesions, crystalloids in preventing them. J Reprod Med. 1996;41:19–26.PubMedGoogle Scholar
  31. 31.
    Demco L. Pain mapping of adhesions. J Am Assoc Gynecol Laparosc. 2004;11:181–3.CrossRefPubMedGoogle Scholar
  32. 32.
    Zinther NB, Fedder J, Friis-Andersen H. Noninvasive detection and mapping of intraabdominal adhesions: a review of the current literature. Surg Endosc. 2010;24:2681–6.CrossRefPubMedGoogle Scholar
  33. 33.
    Seow KM, Lin YH, Hsieh BC, et al. Transvaginal three-dimensional ultrasonography combined with serum CA 125 level for the diagnosis of pelvic adhesions before laparoscopic surgery. J Am Assoc Gynecol Laparosc. 2003;10:320–6.CrossRefPubMedGoogle Scholar
  34. 34.
    Reid S, Lu C, Hardy N, et al. Office gel sonovaginography for the prediction of posterior deep infiltrating endometriosis: a multicenter prospective observational study. Ultrasound Obstet Gynecol. 2014;44:710–8.CrossRefPubMedGoogle Scholar
  35. 35.
    Kikuchi I, Kuwatsuru R, Yamazaki K, et al. Evaluation of the usefulness of the MRI jelly method for diagnosing complete cul-de-sac obliteration. Biomed Res Int. 2014;2014 Article ID 437962, 7 pagesGoogle Scholar
  36. 36.
    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.CrossRefPubMedGoogle Scholar
  37. 37.
    Meuleman T, Schreinemacher MH, van Goor H. Adhesion awareness: a nationwide survey of gynaecologists. Eur J Obstet Gynecol Reprod Biol. 2013;169:353–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Schreinemacher MH, ten Broek RP, Bakkum EA, et al. Adhesion awareness: a national survey of surgeons. World J Surg. 2010;34:2805–12.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Hirschelmann A, Wallwiender CW, Wallwiender M, et al. Is patient education about adhesions a requirement in abdominopelvic surgery? Geburtshilfe Frauenheilkd. 2012;72:299–304.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Granata M, Tsimpanakos I, Moeity F, Magos A. Are we underutilizing Palmer's point entry in gynecologic laparoscopy? Fertil Steril. 2010;94:2716–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Aust TR, Salma IK, Rowlands DJ. Direct optical entry through Palmer’s point: a new technique for those at risk of entry-related trauma at laparoscopy. General Surg. 2009;7:315–7.Google Scholar
  42. 42.
    Tinelli A, Malvasi A, Guido M, et al. Laparoscopy entry in patients with previous abdominal and pelvic surgery. Surg Innov. 2011;18:201–5.CrossRefPubMedGoogle Scholar
  43. 43.
    Diamond MP, Daniell JF, Feste J, et al. Adhesion reformation and de novo adhesion formation after reproductive pelvic surgery. Fertil Steril. 1987;47:864–6.CrossRefPubMedGoogle Scholar
  44. 44.
    Diamond MP, Freeman ML. Clinical implications of postsurgical adhesions. Hum Reprod Update. 2001;7:567–76.CrossRefPubMedGoogle Scholar
  45. 45.
    Swank DJ, Swank-Bordewijk SC, Hop WC, et al. Laparoscopic adhesiolysis in patients with chronic abdominal pain: a blinded randomised controlled multi- centre trial. Lancet. 2003;361:1247–51.CrossRefPubMedGoogle Scholar
  46. 46.
    YC C, Reading I, Bailey S, Sadek K, Ledger W, TC L. Should women with chronic pelvic pain have adhesiolysis? BMC Womens Health. 2014;14:36.CrossRefGoogle Scholar
  47. 47.
    Schietroma M, Carlei F, Altilia F, et al. The role of laparoscopic adhesiolysis in chronic abdominal pain. Minerva Chir. 2001;56:461–5.PubMedGoogle Scholar
  48. 48.
    Tulandi T, Collins JA, Burrows E, et al. Treatment-dependent and treatment- independent pregnancy among women with periadnexal adhesions. Am J Obstet Gynecol. 1990;162:354–7.CrossRefPubMedGoogle Scholar
  49. 49.
    Practice Committee of American Society for Reproductive Medicine with Society of Reproductive Surgeons. Pathogenesis, consequences, and control of peritoneal adhesions in gynecologic surgery: a committee opinion. Fertil Steril. 2013;99:1550–5.CrossRefGoogle Scholar
  50. 50.
    DeWilde RL, Bakkum EA, Brölmann H, et al. Consensus recommendations on adhesions (version 2014) for the ESGE Adhesions Research Working Group (European Society for Gynecological Endoscopy): an expert opinion. Arch Gynecol Obstet. 2014;290:581–2.CrossRefGoogle Scholar
  51. 51.
    DeWilde RL, Trew G, on behalf of the Expert Adhesions Working Party of the European Society of Gynaecological Endoscopy (ESGE). Postoperative abdom- inal adhesions and their prevention in gynaecological surgery. Expert consen- sus position. Gynecol Surg. 2007;4:161–8.CrossRefGoogle Scholar
  52. 52.
    Brochhausen C, Schmitt VH, Planck CN, et al. Current strategies and future perspectives for intraperitoneal adhesion prevention. J Gastrointest Surg. 2012;16:1256–74.CrossRefPubMedGoogle Scholar
  53. 53.
    Hellebrekers BW, Kooistra T. Pathogenesis of postoperative adhesion formation. Br J Surg. 2011;98:1503–16.CrossRefPubMedGoogle Scholar
  54. 54.
    Kraemer B, Wallwiener C, Rajab TK, et al. Standardised models for inducing experimental peritoneal adhesions in female rats. Biomed Res Int. 2014;2014:435056. doi: 10.1155/2014/435056. Epub 2014 Apr 8CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Carbonnel M et al. Efficacy of transient abdominal ovariopexy in patients with severe endometriosis. Euro J Obstet Gyneco Reprod Biol. 2011;155:183–7.CrossRefGoogle Scholar
  56. 56.
    Ouahba J, Madelenat P, Poncelet C. Transient abdominal ovariopexy for adhesion prevention in patients who underwent surgery for severe pelvic endometriosis. Fertil Steril. 2004;82:1407–11.CrossRefPubMedGoogle Scholar
  57. 57.
    Ten Broek RP, Issa Y, van Santbrink EJ, et al. Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis. BMJ. 2013;347:f5588.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Hackethal A, Sick C, Szalay G, et al. Intra-abdominal adhesion formation: does surgical approach matter? Questionnaire survey of South Asian surgeons and literature review. J Obstet Gynaecol Res. 2011;37:1382–90.CrossRefPubMedGoogle Scholar
  59. 59.
    Risberg B. Adhesions: preventive strategies. Eur J Surg Suppl. 1997;577:32–9.Google Scholar
  60. 60.
    Treutner KH, Schumpelick V. Adhäsionsprophylaxe. Wunsch und Wirklichkeit Chirurg. 2000;71:510–7.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2018

Authors and Affiliations

  • Andreas Hackethal
    • 1
    Email author
  • Jörg Engel
    • 2
  • Hans-Rudolf Tinneberg
    • 3
  • Sebastian F. M. Häusler
    • 4
  1. 1.Gynecology and ObstetricsUniversity Clinic WuerzburgWuerzburgGermany
  2. 2.Department of OB/GynKlinikum AschaffenburgAschaffenburgGermany
  3. 3.University Clinic GiessenDepartment of Gynecology and ObstetricsGiessenGermany
  4. 4.Universitätsfrauenklinik Würzburg, Universitätsklinikum WürzburgWürzburgGermany

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