Adhesiolysis Carries Highest Risk Of Adhesion-Related Readmission


LONDON — The risk of adhesion-related readmission to the hospital after gynecologic surgery is highest among women whose surgery involves adhesiolysis, a finding that highlights the importance of adhesion prevention rather than removal, investigators reported.

In a poster presentation at the annual congress of the International Society for Gynecologic Endoscopy, Adrian Lower, M.D., and associates outlined their previous findings from the first Surgical and Clinical Adhesion Research (SCAR) study: 34% of patients experience at least one adhesion-related readmission (ARR) within 10 years of undergoing laparotomy.

The SCAR-2 study, which assessed only gynecology patients, found similar risks of ARR within the first 4 years of either laparotomy or laparoscopy, said Dr. Lower, a consultant gynecologist at St. Bartholomew's Hospital, London.

Now, results of the SCAR-3 study suggest that among women undergoing laparoscopic gynecologic procedures, either adhesiolysis, or a history of a previous laparotomy are the two greatest risk factors for ARR, he said.

SCAR-3 analyzed the medical records of 6,276 patients who had undergone laparoscopic gynecologic procedures (excluding sterilizations) from 1996 to 1997.

Diagnoses at the time of surgery included endometriosis (18%), inflammatory disease of the female genitalia (12%), and pain (33%).

The study found an overall risk of ARR within 5 years of 2.5%; the two highest risk factors were previous laparotomy, or adhesiolysis.

Patients who had undergone laparotomy before the index laparoscopy had an overall risk of 3.5% for ARR—with procedures on the fallopian tubes or ovaries presenting higher risk (3.9%), compared with hysterectomy (1.8%).

And patients who received adhesiolysis during a laparoscopic procedure had the highest risk of ARR at 6.8%.

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