The incidence of adhesions after prior laparotomy: a laparoscopic appraisal

OBJECTIVE: To relate the presence of intra-abdominal adhesions after laparotomy to the site of incision, repeat laparotomy, and the clinical indication for prior surgery. METHODS: Three hundred sixty women undergoing operative laparoscopy after a previous laparotomy were assessed for adhesions between the abdominal wall and the underlying omentum and bowel. Complications resulting directly from these adhesions were documented. RESULTS: Patients with prior midline incisions had significantly more adhesions (58 of 102) than those with Pfannenstiel incisions (70 of 258). Patients with midline incisions performed for gynecologic indications had significantly more adhesions (109 of 259) than all types of incisions performed for obstetric indications (12 of 55). The presence of adhesions in patients with previous obstetric surgery was not affected by the type of incision. Adhesions to the bowel were significantly more frequent after midline incisions above the umbilicus. Twenty-one women suffered direct injury to adherent omentum and bowel during the laparoscopic procedure. CONCLUSIONS: Intra-abdominal adhesions between the abdominal scar and underlying viscera are a common consequence of laparotomy. Patients undergoing laparoscopy after a previous laparotomy should be considered at risk for the presence of adhesions between the old scar and the bowel and omentum.

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