Adhesions after abdominal surgery in children.
OBJECTIVE
The objective of this study is to quantify the overall burden (operative and nonoperative) of small bowel obstruction caused by adhesions after laparotomy in children.


METHODS
Data from the Scottish National Health Service Medical Record Linkage database were used to assess risk of an adhesion-related readmission in the 5 years after open abdominal surgery in children and adolescents younger than 16 years from April 1996 to March 1997.


RESULTS
A total of 1581 children underwent abdominal surgery (ie, from duodenum downward). Patients undergoing surgery on the ileum had the highest risk of readmission because of adhesions in the subsequent 5 years after surgery (9.2%)--formation/closure of ileostomy had the greatest risk (25%); 6.5% of children were readmitted after general laparotomy, 4.7% after duodenal surgery, and 2.1% after colonic surgery. The incidence of readmissions was 0.3% after appendicectomy. The overall readmission rate was 5.3% (if appendicectomy was excluded) and 1.1% (if appendicectomy was included).


CONCLUSIONS
This population-based study has demonstrated that children have a high incidence of readmissions owing to adhesions after lower abdominal surgery. The risks are related to the site and the type of the original surgery. The risk of further readmissions was highest in the first year but continued with time. The data enable surgeons to target antiadhesion strategies at procedures that lead to a high risk of adhesions.
Grant
Hugh W
HW
Department of Paediatric Surgery, Children's Hospital, John Radcliffe Hospital, OX3 9DU Oxford, UK. hugh.grant@orh.nhs.uk
Parker
Michael C
MC
Wilson
Malcolm S
MS
Menzies
Donald
D
Sunderland
Graham
G
Thompson
Jeremy N
JN
Clark
David N
DN
Knight
Alastair D
AD
Crowe
Alison M
AM
Ellis
Harold
H
D034861:Abdominal Wall / Q000601:surgery; D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology*; D007813:Laparotomy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012606:Scotland; D012720:Severity of Illness Index; D017678:Sex Distribution; D000267:Tissue Adhesions / Q000453:epidemiology* / Q000209:etiology; D016896:Treatment Outcome