THE INCIDENCE OF ADHESIONS AFTER PRIOR LAPAROTOMY - A LAPAROSCOPIC APPRAISAL

Objective: To relate the presence of intra-abdominal adhesions after l aparotomy to the site of incision, repeat laparotomy, and the clinical indication for prior surgery. Methods: Three hundred sixty women unde rgoing operative laparoscopy after a previous laparotomy were assessed for adhesions between the abdominal wall and the underlying omentum a nd bowel. Complications resulting directly from these adhesions were d ocumented. Results: Patients with prior midline incisions had signific antly more adhesions (58 of 102) than those with Pfannenstiel incision s (70 of 258). Patients with midline incisions performed for gynecolog ic indications had significantly more adhesions (109 of 259) than all types of incisions performed for obstetric indications (12 of 55). The presence of adhesions in patients with previous obstetric surgery was not affected by the type of incision. Adhesions to the bowel were sig nificantly more frequent after midline incisions above the umbilicus. Twenty-one women suffered direct injury to adherent omentum and bowel during the laparoscopic procedure. Conclusions: Intra-abdominal adhesi ons between the abdominal scar and underlying viscera are a common con sequence of laparotomy. Patients undergoing laparoscopy after a previo us laparotomy should be considered at risk for the presence of adhesio ns between the old scar and the bowel and omentum.