title: Effect of previous surgery on abdominal opening time.
abstract: OBJECTIVE
  The purpose of this study was to document prospectively the time required to gain access to the abdomen to perform a planned procedure in patients with and without previous surgery.
  
  
  METHODS
  Patients were obtained from the consecutive cases of 11 surgeons at three colorectal surgery centers. Opening time (skin incision to retractor placement) was measured and recorded in the operating room by the circulating nurse or by an independent researcher. Demographic data including the number and type of previous operations and the presence and severity of adhesions were recorded by the staff surgeon. A comparison of opening times between patients with and without previous abdominal operations was conducted.
  
  
  RESULTS
  One hundred ninety-eight patients had abdominal operations. Fifty-five percent had previous abdominal procedures. Patients with prior surgery required a mean of 21 minutes to open their abdomens, whereas patients without prior surgery required a mean of 6 minutes (P < 0.01). The median times were 17 and 6 minutes, respectively. Eighty-three percent of patients with prior surgery had adhesions, whereas only 7 percent of patients had adhesions on their initial operation. Patients with prior surgery also had higher grade adhesions (P < 0.001). Irrespective of previous surgery, comparing patients with adhesions with those without, patients with adhesions required a mean of 22 minutes to open, whereas the lack of adhesions resulted in a mean opening time of 6 minutes.
  
  
  CONCLUSIONS
  Previous surgery and the presence of adhesions add significant time to opening the abdomen.
authors.affiliation: Department of Colon and Rectal Surgery, Ochsner Clinic, New Orleans, Louisiana, USA.
authors.forename: D E
authors.initials: DE
authors.lastname: Beck
authors.forename: M A
authors.initials: MA
authors.lastname: Ferguson
authors.forename: F G
authors.initials: FG
authors.lastname: Opelka
authors.forename: J W
authors.initials: JW
authors.lastname: Fleshman
authors.forename: P
authors.initials: P
authors.lastname: Gervaz
authors.forename: S D
authors.initials: SD
authors.lastname: Wexner
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011336:Probability; D011446:Prospective Studies; D012086:Reoperation; D018570:Risk Assessment; D012737:Sex Factors; D013997:Time Factors