COMMENTARY

Visceral Adhesion Burden Remains High With Laparoscopic Colorectal Surgery

Albert B. Lowenfels, MD

Disclosures

May 30, 2018

Are there differences in the frequency of abdominal adhesions between open and laparoscopic operations? The authors of a study, published in Annals of Surgery ,[1] obtained information on the extent of adhesion formation at the time that a second operation was performed to resect colorectal liver metastases. Of the 151 patients included in the study, 90 initially underwent open colorectal resection and 61 received a laparoscopic resection.

During the second operation to remove the liver cancer, 71 patients (78.9%) with prior open surgery versus 23 patients (37.7%) with prior laparoscopic surgery had adhesions at the previous incisions (P < .001). With respect to visceral adhesions, 53 of patients (58.9%) with prior open surgery and 27 of patients (44.3%) with prior laparoscopic surgery had evidence of visceral adhesions (P = .077).

Viewpoint

Intuitively, one would anticipate that laparoscopic surgery would result in fewer adhesions than would open operations because of the larger incisions required for open surgery. Although this proved to be true, visceral adhesions between bowel organs still remain frequent in patients originally operated laparoscopically.

This report supplies much needed information about adhesion formation after laparoscopic surgery and emphasizes that adhesion formation, particularly between abdominal viscera with the potential to result in intestinal obstruction, will remain a common problem despite the increasing use of laparoscopic surgery. Other regimens to help prevent adhesion formation will still be useful following laparoscopic abdominal surgery.[2]

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