Abstract
PURPOSE: The purpose of this study was to document prospectively the time required to gain access to the abdomen to perform a planned procedure in patients with and without previous surgery. METHODS: Patients were obtained from the consecutive cases of 11 surgeons at three colorectal surgery centers. Opening time (skin incision to retractor placement) was measured and recorded in the operating room by the circulating nurse or by an independent researcher. Demographic data including the number and type of previous operations and the presence and severity of adhesions were recorded by the staff surgeon. A comparison of opening times between patients with and without previous abdominal operations was conducted. RESULTS: One hundred ninety-eight patients had abdominal operations. Fifty-five percent had previous abdominal procedures. Patients with prior surgery required a mean of 21 minutes to open their abdomens, whereas patients without prior surgery required a mean of 6 minutes (P<0.01). The median times were 17 and 6 minutes, respectively. 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 those 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 significant time to opening the abdomen.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ellis H. The clinical significance of adhesions: Focus on intestinal obstruction. Eur J Surg 1997;577(Suppl):5–9.
Beck DE, Opelka FG, Bailey HR, Rauh SM, Pashos CL. Incidence of small-bowel obstruction and adhesiolysis after open colorectal and general surgery. Dis Colon Rectum 1999;42:241–8.
Thompson JN, Whawell SA. Pathogenesis and prevention of adhesions formation. Br J Surg 195;82:3–5.
Becker JM, Dayton MT, Fazio VW,et al. Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomized, double-blind multicenter study. J Am Coll Surg 1996;183:297–306.
Monk BJ, Berman ML, Montz FJ. Adhesions after extensive gynecologic surgery: clinical significance, etiology, and prevention. Am J Obstet Gynecol 1994;170:1396–403.
Risberg B. Adhesions. Prevention Strategies. Eur J Surg 1997;163(Suppl 577):32–9.
Menzies D. Peritoneal adhesions: incidence, cause, and prevention. Surg Ann 1992;24:27–45.
Menzies D, Ellis H. Intestinal obstruction from adhesions—how big is the problem? Ann R Coll Surg Engl 1990;72:60–3.
van der Krabben AA, Dijkstra FR, Nieuwenhuijzen M, Reijnen MM, Schaapveld M, van Goor H. Morbidity and mortality of inadvertent enterotomy during adhesiotomy. Br J Surg 2000;87:467–71.
Ellis H, Moran BJ, Thompson JN,et al. Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet 1999;353:1476–80.
Ray NF, Denton WG, Thamer M, Henderson SC, Perry S. Abdominal adhesiolysis: inpatient care and expenditures in the United States in 1994. J Am Coll Surg 1998;186:1–9.
Coleman MG, McLain AD, Moran BJ. Impact of previous surgery on time taken for incision and division of adhesions during laparotomy. Dis Colon Rectum 2000;43:1297–9.
Author information
Authors and Affiliations
About this article
Cite this article
Beck, D.E., Ferguson, M.A., Opelka, F.G. et al. Effect of previous surgery on abdominal opening time. Dis Colon Rectum 43, 1749–1753 (2000). https://doi.org/10.1007/BF02236862
Issue Date:
DOI: https://doi.org/10.1007/BF02236862