Anterior abdominal wall adhesions after laparotomy or laparoscopy.
OBJECTIVE
To determine the frequency of postoperative adhesions to the anterior abdominal wall peritoneum that could affect safe placement of the initial laparoscopic umbilical cannula at subsequent procedures.


METHODS
Prospective cohort study.


METHODS
Reproductive endocrinology and infertility service of a tertiary care referral hospital.


METHODS
Two hundred fifteen women, 124 with prior abdominal surgery and 91 with no prior surgery.


METHODS
Surgical histories were reviewed, abdominal skin scars noted, and extent of anterior abdominal wall adhesions prospectively recorded. Statistical analysis was performed with the chi2 test.


RESULTS
No anterior abdominal wall adhesions were present in 91 patients with no previous surgery or 45 patients with previous laparoscopy (12 had more than 1 laparoscopy; p <0.001 vs laparotomy). Seventeen (59%) of 29 patients with a midline vertical incision had anterior wall adhesions (p <0.05 vs suprapubic transverse incision). Eleven (28%) of 39 with a suprapubic transverse incision had anterior wall adhesions (p <0.001 vs no surgery or laparoscopy). Ninety-six percent of adhesions involved omentum and 29% included bowel.


CONCLUSIONS
Prior laparotomy, whether through a midline vertical or suprapubic transverse incision, significantly increased the frequency of anterior abdominal wall adhesions, and these adhesions may complicate the placement of the laparoscopic cannula through the umbilicus.
Levrant
S G
SG
Advanced Reproductive Health Care, Suite 230, 14315 South 108th Avenue, Orland Park, IL 60462, USA.
Bieber
E J
EJ
Barnes
R B
RB
D000009:Abdominal Muscles / Q000601:surgery; D002404:Catheterization; D015331:Cohort Studies; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D000267:Tissue Adhesions / Q000453:epidemiology* / Q000209:etiology