-- Tina ShelbyPost-op adhesions often lead to more surgery (Last updated 1:13 PM ET April 30)
NEW YORK, Apr 30 (Reuters Health) -- Adhesions -- fibrous bands or "internal scars" common after abdominal surgery -- are a frequent cause of hospital readmissions and subsequent surgeries, according to a report.
More care should be taken to prevent the formation of adhesions, UK researchers suggest. Their report is published in the May 1st issue of The Lancet.
A survey of Scottish patients revealed that "at least one in 18... readmissions (for operative and non-operative treatment) were directly related to adhesions," according to a team led by Dr. Harold Ellis of The Guy's, King's College and St. Thomas's School of Biomedical Sciences in London, UK.
Adhesions are fibrous bands of scar tissue that form within days, months, or even years of abdominal surgery. Studies show that almost 95% of patients who have undergone such surgery develop adhesions. While most adhesions cause patients no harm, a minority can lead to complications, such as intestinal blockage or, in women, infertility. Repeat surgery is the only method of adhesion removal.
Ellis and colleagues used government databases to track the 10-year medical histories of 29,790 Scottish citizens admitted for pelvic or abdominal surgeries in 1986.
They report that 34.6% of these patients were later readmitted to the hospital "for a disorder directly or possibly related to adhesions, or for... surgery that could be potentially complicated by adhesions." Close to 6% of all readmissions were directly linked to complications caused by adhesions.
Scar tissue formation following intestinal surgeries "had the highest percentage of readmissions directly related to adhesions (7.3%)," according to the authors. Nearly 3% of women undergoing gynecological surgeries needed subsequent surgery because of adhesions.
Because surgical removal of these scar tissues may not prevent reoccurrence of an adhesion at the same site, experts believe prevention is the best method of reducing the number of these postoperative complications. In a commentary, Dr. Lena Holmdahl of Goteborg University in Sweden, notes that medicated or procedural therapies performed during surgery can reduce the likelihood of the formation of these "surgical footprints." She is optimistic that the UK study "will stimulate the industry, administrators, and surgeons alike to acknowledge the size of the problem posed by adhesions and to act."
SOURCE: The Lancet 1999;353:1476-1480, 1456-1457.