Laparoscopic and Open Colorectal Surgery in Previously Operated Patients is Associated with Considerable Need for Adhesiolysis

ABSTRACT

Background: Adhesions caused by previous operations increase operative time and the risk of peroperative complications as well as conversions. The aim of this study was to evaluate the complications and the extra operative time related to the dividing of adhesions caused by previous surgery in patients scheduled for elective colorectal surgery. Methods: In a consecutive series of patients with previous abdominal or pelvic surgery and scheduled for open or laparoscopic colorectal procedures, data on patient demography, previous operations, index operations, intraoperative complications, conversions, adhesion division time and the extra time needed for first trocar insertion were collected prospectively. Results: Data from 111 patients were collected. There were 29 open and 80 laparoscopic operations, and conversion was needed in two patients due to adhesions. The mean extra time needed to divide adhesions was 19.9 min (range 0.2-120 min) in open operations, 35.4 min (range 22.9-48 min) in converted cases and 9.5 min (range 0-67 min) in laparoscopic operations. The extra time corresponded for 12% of total operative time. The mean extra time needed to insert the first trocar was 1 min (range 0-8 min). There were two serosal lesions necessitating suturation (one in open and one in laparoscopic operation) and one inadvertent enterotomy. The extra time needed to divide adhesions was correlated with the number of previous operations. Conclusions: Adhesions caused by previous surgery increase operative time considerably. The increase correlates with the number of previous operations. The adhesiolysis is associated with certain amount of intraoperative complications.