Effect of previous surgery on abdominal opening time

PURPOSE: The purpose of this study was to document prospectively the time r equired to gain access to the abdomen to perform a planned procedure in pat ients with and without previous surgery. METHODS: Patients were obtained fr om the consecutive cases of 11 surgeons at three colorectal surgery centers . Opening time (skin incision to retractor placement) was measured and reco rded in the operating room by the circulating nurse or by an independent re searcher. Demographic data including the number and type of previous operat ions and the presence and severity of adhesions were recorded by the staff surgeon. ri comparison of opening times between patients with and without p revious abdominal operations was conducted. RESULTS: One hundred ninety-eig ht patients had abdominal operations. Fifty-five percent had previous abdom inal procedures. Patients with prior surgery required a mean of 21 minutes to open their abdomens, whereas patients without prior surgery required a m ean of 6 minutes (P < 0.01). The median times were 17 and 6 minutes, respec tively. Eighty-three percent of patients with prior surgery had adhesions, whereas only 7 percent of patients had adhesions on their initial operation . Patients with prior surgery also had higher grade adhesions (P < 0.001). Irrespective of previous surgery, comparing patients with adhesions with th ose without, patients with adhesions required a mean of 22 minutes to open, whereas the lack of adhesions resulted in a mean opening time of 6 minutes . CONCLUSIONS: Previous surgery and the presence of adhesions add significa nt time to opening the abdomen.