Reoperation on the abdomen encased in adhesions.
OBJECTIVE
To determine outcome after lysis of intestinal adhesions, relief of obstruction, closure of fistulas and drainage of abscesses in patients with an abdominal cavity obliterated by chronic postoperative adhesions.


METHODS
Among 40 patients with an abdomen encased in dense adhesions after a mean of 5 previous operations, 31 patients also had intestinal obstruction, 25 enteric fistulas and 20 abdominal abscesses. Reoperation was done and outcome assessed from the medical records and by a mailed questionnaire.


RESULTS
Only 1 postoperative death occurred, but 24 early complications appeared. At hospital discharge, obstruction, fistula and abscess were completely resolved in all but 3 patients (P <0.001). Only 2 of 16 patients on parenteral nutrition before operation (TPN) still required it (P = 0.004). At late follow-up (mean, 4.6 years) the patients' quality of life (mean score +/- SD, 8.6 +/- 2.1) was similar to that of a healthy control population (9.2 +/- 1.2, P = 0.17).


CONCLUSIONS
Reoperation on the abdomen encased in adhesions restores most patients to good health and an excellent long-term quality of life.
Harris
Eric A
EA
Department of Surgery, Mayo Clinic Scottsdale, 13400 East Shea Blvd., Scottsdale, AZ 85255, USA.
Kelly
Ann W
AW
Pockaj
Barbara A
BA
Heppell
Jacques
J
Hentz
Joseph G
JG
Kelly
Keith A
KA
D000005:Abdomen; D018784:Abdominal Abscess / Q000150:complications / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004435:Eating; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications / Q000601:surgery*; D007415:Intestinal Obstruction / Q000150:complications / Q000601:surgery*; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011788:Quality of Life; D020127:Recovery of Function; D012008:Recurrence; D012086:Reoperation; D013997:Time Factors; D000267:Tissue Adhesions / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome