title: Long-term impact of adhesions on bowel obstruction.
abstract: BACKGROUND
  The incidence of reoperation for adhesive bowel obstruction after general abdominal surgery is 2.5% and carries a considerable risk of mortality and morbidity. Adhesions account for 56% of all cases of bowel obstruction. Most epidemiologic knowledge regarding adhesive bowel obstruction is derived from data of national registries and retrospective cohorts of elective abdominal surgery. Because of the design of these studies, it remains unknown whether specific operative factors impact the occurrence of bowel obstruction. We aimed to comprehensively assess risk factors for the incidence of adhesive bowel obstruction with emphasis on intraoperative surgical factors.
  
  
  METHODS
  Follow-up study of the prospective LAPAD study (LAParotomy or LAParoscopy and Adhesions study; clinicaltrials.gov registration number: NCT01236625) that included patients undergoing all types of elective open or laparoscopic abdominal surgery. The primary endpoint of this study was (suspected) adhesive bowel obstruction. Univariable and multivariable logistic regression analysis were used to assess risk factors.
  
  
  RESULTS
  A total of 604 (88%) of 715 patients were included; 38 (6%) patients experienced an episode of adhesive bowel obstruction. Surgery on the lower gastrointestinal tract (odds ratio 4.57, P < .01) and the severity of adhesions in the operative area (odds ratio 2.37, P = .04) independently increased the risk for adhesive small bowel obstruction.
  
  
  CONCLUSIONS
  Patients undergoing surgery on the lower gastrointestinal tract and patients with more severe adhesions present at surgery have an increased risk for adhesive bowel obstruction.
authors.affiliation: Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: chemastrik@gmail.com.
authors.forename: Chema
authors.initials: C
authors.lastname: Strik
authors.affiliation: Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Martijn W J
authors.initials: MW
authors.lastname: Stommel
authors.affiliation: Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Schipper
authors.affiliation: Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Harry
authors.initials: H
authors.lastname: van Goor
authors.affiliation: Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Richard P G
authors.initials: RP
authors.lastname: Ten Broek
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology*; D007432:Intraoperative Period; D010535:Laparoscopy; D007813:Laparotomy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D012307:Risk Factors; D000267:Tissue Adhesions / Q000453:epidemiology / Q000209:etiology*