Morbidity and mortality of inadvertent enterotomy during adhesiotomy

Background: Inadvertent enterotomy is a feared complication of adhesiotomy during abdominal reoperation. The nature and extent of this adhesion-associ ated problem are unknown. Methods: The records of all patients who underwent reoperation between July 1995 and September 1997 were reviewed retrospectively for inadvertent ente rotomy, risk factors were analysed using univariate and multivariate parame ters, and postoperative morbidity and mortality rates were assessed. Results: Inadvertent enterotomy occurred in 52 (19 per cent) of 270 reopera tions. Dividing adhesions in the lower abdomen and pelvis, in particular, c aused bowel injury. In univariate analysis body mass index was significantl y higher in patients with inadvertent enterotomy (mean(s.d.) 25.5(4.6) kg/m (2) ) than in those without enterotomy (21.9(4.3) kg/m(2) ) (P < 0.03). Pat ient age and three or more previous laparotomies appeared to be independent parameters predicting inadvertent enterotomy (odds ratio (95 per cent conf idence interval) 1.9 (1.3-2.7) and 10.4 (5.0-21.6) respectively; P < 0.001) . Patients with inadvertent enterotomy had significantly more postoperative complications (P < 0.01) and urgent relaparotomies (P < 0.001), a higher r ate of admission to the intensive care unit (P < 0.001) and parenteral nutr ition usage (P < 0.001), and a longer postoperative hospital stay (P < 0.00 1). Conclusion: The incidence of inadvertent enterotomy during reoperation is h igh. This adhesion-related complication has an impact on postoperative morb idity.