title: Impact of Adhesiolysis on Outcome of Colorectal Surgery.
abstract: OBJECTIVE
  Adhesiolysis is a frequent part of colorectal surgery, potentially impeding the operation and causing inadvertent bowel injury. Such difficulties might compromise convalescence and oncological quality of resection. The aim of this prospective cohort study was to assess the impact of adhesiolysis on clinical outcomes and histopathological results in colorectal surgery.
  
  
  METHODS
  Colorectal procedures were selected from a prospective cohort study of adhesiolysis-related problems. We compared the incidence of bowel injury, morbidity, costs, and the histopathology between patients undergoing elective colorectal surgery with or without adhesiolysis.
  
  
  RESULTS
  Two hundred and forty nine colorectal surgeries were analysed. Adhesiolysis was required in 59.0%. The mean adhesiolysis time was 28 min. In the adhesiolysis group, enterotomies occurred in 6.1% and seromuscular injuries in 27.2% compared to 0 and 6.9% respectively in the non-adhesiolysis group (p = 0.012 and p < 0.001). In patients requiring adhesiolysis, 29.9% had major surgery-related complications (MSRC) compared to 15.7% without adhesiolysis (p = 0.007). There were no statistically significant differences regarding inpatient costs and resection margin or number of harvested lymph nodes.
  
  
  CONCLUSIONS
  Adhesiolysis during colorectal surgery is related to an increased incidence of iatrogenic bowel injuries and MSRC. Despite the technical challenges associated with adhesiolysis, good histopathological results were obtained in oncological resections.
authors.affiliation: Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Martijn W J
authors.initials: MW
authors.lastname: Stommel
authors.forename: Chema
authors.initials: C
authors.lastname: Strik
authors.forename: Richard P G
authors.initials: RP
authors.lastname: ten Broek
authors.forename: Johannes H W
authors.initials: JH
authors.lastname: de Wilt
authors.forename: Harry
authors.initials: H
authors.lastname: van Goor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000150:complications / Q000191:economics / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000191:economics; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007422:Intestines / Q000293:injuries; D007431:Intraoperative Complications / Q000191:economics / Q000453:epidemiology / Q000209:etiology*; D010535:Laparoscopy / Q000191:economics; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*; D000267:Tissue Adhesions / Q000150:complications / Q000191:economics / Q000601:surgery*