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General Aspects and Their Handling: Adhesions

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Hysterectomy

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Abstract

Intraabdominal adhesions are the most frequent complication of abdominal surgery and may represent one of the greatest unsolved problems in medicine today. They severely diminish quality of life of many patients who are affected by bowel obstruction, infertility and chronic abdominal pain. Hence, adhesions and their consequences are associated with high morbidity, a considerable risk of mortality as well as an increasing burden of medicolegal claims and socioeconomic expenses. This chapter summarizes key steps in anticipating, diagnosing and treating intraabdominal adhesions. Additionally, strategies to reduce adhesions formation are summarized. Up to 90 % of previously operated patients may have adhesions, most are asymptomatic. There is no standard imaging modality available to safely identify or rule out adhesions. In patients with clinically expected intraabdominal adhesions, adequate surgical steps (patient consent, adjustment of abdominal entry as an example) should be followed. There is strong evidence to lyse potentially symptomatic adhesions, whereas adhesiolysis in asymptomatic patients may not have a benefit. Patients with an increased individual risk of adhesion formation could be treated with anti-adhesion products. Although some of these products proofed successfully to reduce adhesion formation in several clinical trials, their usage is limited due to financial considerations. Further, it is highly recommended to clarify the adhesion formation risk and related complications during written consent before every surgery.

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Author information

Authors and Affiliations

  1. Gynecology and Obstetrics, University Clinic Wuerzburg, Wuerzburg, 97080, Germany

    Andreas Hackethal

  2. Department of OB/Gyn, Klinikum Aschaffenburg, Aschaffenburg, 63739, Germany

    Jörg Engel

  3. University Clinic Giessen, Department of Gynecology and Obstetrics, Giessen, Germany

    Hans-Rudolf Tinneberg

  4. Universitätsfrauenklinik Würzburg, Universitätsklinikum Würzburg, Würzburg, 97080, Germany

    Sebastian F. M. Häusler

Authors
  1. Andreas Hackethal
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  2. Jörg Engel
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  3. Hans-Rudolf Tinneberg
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  4. Sebastian F. M. Häusler
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Correspondence to Andreas Hackethal .

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Editors and Affiliations

  1. Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany

    Ibrahim Alkatout

  2. Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany

    Liselotte Mettler

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Hackethal, A., Engel, J., Tinneberg, HR., Häusler, S.F.M. (2018). General Aspects and Their Handling: Adhesions. In: Alkatout, I., Mettler, L. (eds) Hysterectomy. Springer, Cham. https://doi.org/10.1007/978-3-319-22497-8_26

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  • DOI: https://doi.org/10.1007/978-3-319-22497-8_26

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