The Magnitude of the Problem of Adhesions
The rate
of adhesion formation after surgery is surprising
given the relative lack of knowledge about ADHESIONS
among doctors and patients alike. From autopsies
on victims of traffic accidents, Weibel and Majno
(1973) found that 67% of patients who had undergone
surgery had adhesions. This number increased
to 81% and 93% for patients with major and multiple
procedures respectively. Similarly, Menzies
and Ellis (1990) found that 93% of patients who had
undergone at least one previous abdominal operation
had adhesions, compared with only 10.4% of patients
who had never had a previous abdominal operation.
Furthermore, 1% of all laparotomies developed obstruction
due to adhesions within one year of surgery with 3%
leading to obstruction at some time after surgery.
Of all cases of small bowel obstruction, 60-70% of
cases involve adhesions (Ellis, 1997).
Lastly, following surgical treatment of adhesions
causing intestinal obstruction, obstruction due to
adhesion reformation occurred in 11 to 21% of cases
(Menzies, 1993).
Between 55
and 100% of patients undergoing pelvic reconstructive
surgery will form adhesions.
The impact of adhesions as a complication of surgery
is huge. In the United States (1993) 347,000
operations for lysis of peritoneal adhesions were
performed (Graves, 1995), of which about 100,000 involved
intestinal adhesions. Estimated another way,
446,000 procedures were performed in the U.S. to lyse
abdominopelvic adhesions in 1993 (HCIA, 1994).
In 1988, there were about 280,000 hospitalizations
for adhesions, the economic cost of which was estimated
conservatively as $1.2 billion per year (Fox Ray et
al., 1993).
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