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Identifying risk factors for abdominal adhesions: preliminary findings of a prospective study

      Objectives

      The objective of this study is to identify relevant risk factors for development of abdominal and pelvic adhesions in women based on their prior medical and surgical history. The primary outcome of this study is the presence and severity of adhesions identified at the time of laparoscopy for benign gynecologic disease.

      Materials and Methods

      This multi-site prospective study was approved by local IRB board. All laparoscopic cases performed by study staff on adult patients were eligible for inclusion. The anticipated study size is a minimum of 1,000 cases in an effort to account for more rare adhesion-promoting conditions. Cases were performed per standard protocol with entry approach and location per surgeon preference. Intraoperative photo documentation of four abdominal quadrants was obtained at the onset of each case. Following the case, a survey form was completed (Fig 1) to capture data on adhesiogenic events, time spent for adhesiolysis, route of entry, location, and grade of adhesions (Fig 2), if present.

      Results

      Herein we present interval findings from study onset in 2019 until 2021. A total of 490 laparoscopic cases have been collected, with an overall adhesion incidence of 58.98%. The most common prior inflammatory event was presence of endometriosis; among the endometriosis cases with no prior surgeries, the adhesion incidence was 61.29%. The most common preceding abdominal surgical event was a Cesarean section, with 82 patients having one or more prior Cesareans. Adhesions were present in 87.8% of cases with prior Cesarean, predominantly in the lower or midcentral abdomen and requiring on average 18.5 minutes of adhesiolysis; 44.4% of the adhesions were classified as filmy, 33.3% as dense, and 22.2% as cohesive. The second most common laparotomic procedure was abdominal myomectomy (n=22), of which 90.1% had adhesions predominantly in the central lower pelvis. There was a relatively even distribution of adhesion types, requiring an average of 24.4minutes of adhesiolysis. This is in contrast to the cases of laparoscopic myomectomy without prior abdominal surgery (n=10), of which 80% had adhesions noted in the lower or mid pelvis. These adhesions were filmy in 75% of the cases and required an average of 14.8 minutes for adhesiolysis.

      Conclusion

      Our preliminary findings highlight the need for vigilance regarding anticipated intraabdominal adhesions. We anticipate that upon collecting a complete dataset, a model can be established for predicting risk factors for the development of abdominal adhesions. This project has important clinical implications and enables the provider to better counsel patients on rates of postoperative adhesion development, as well as guide operative decision-making for site of abdominal entry.
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