ANTERIOR ABDOMINAL-WALL ADHESIONS AFTER LAPAROTOMY OR LAPAROSCOPY

Study Objective. To determine the frequency of postoperative adhesions to the anterior abdominal wall peritoneum that could affect sale plac ement of the initial laparoscopic umbilical cannula at subsequent proc edures. Design. Prospective cohort study. Setting. Reproductive endocr inology and infertility service of a tertiary care referral hospital. Patients. Two hundred fifteen women, 124 with prior abdominal surgery and 91 with no prior surgery. Interventions. Surgical histories were r eviewed, abdominal skin scars noted, and extent oi anterior abdominal wall adhesions prospectively recorded. Statistical analysis was perfor med with the chi(2) test. Measurements and Main Results. No anterior a bdominal wall adhesions were present in 91 patients with no previous s urgery or 45 patients with previous laparoscopy (12 had more than 1 la paroscopy; p < 0.001 vs laparotomy). Seventeen (59%) of 29 patients wi th a midline vertical incision had anterior wall adhesions (p < 0.05 v s suprapubic transverse incision). Eleven (28%) of 39 with a suprapubi c transverse incision had anterior wall adhesions (p < 0.001 vs no sur gery or laparoscopy). Ninety-six percent of adhesions involved omentum and 29% included bowel. Conclusion. Prior laparotomy, whether through a midline vertical or suprapubic transverse incision, significantly i ncreased the frequency of anterior abdominal wall adhesions, and these adhesions may complicate the placement of the laparoscopic cannula th rough the umbilicus.