Article: Peritoneal Adhesions - Medical Litigation News

PERITONEAL ADHESIONS

Adhesion formation following abdominal or pelvic surgery is almost universal (94%)[1]. By contrast, only 1 in 10 patients have adhesions at first laparotomy.

Nearly all (97%) patients who had adhesions released during a laparoscopic procedure had reformed them within 3 months. Only 12% of those not requiring such adhesiolysis developed de novo adhesions in the same period[2].

Individual susceptibility appears to determine severity of the reaction to surgery. Between 1%¹ and 11%^2a of patients undergoing abdominal surgery will develop intestinal obstruction from adhesions within the first year.

PRACTICE POINT

Adhesion formation is almost universal after abdominal and pelvic surgery

There is evidence[3] that the revered surgical practice of closing the peritoneal incision with sutures encourages adhesion formation: it may in some circumstances be unnecessary. Conversely, leaving abdominal or pelvic organs partially uncovered after surgery encourages adhesion formation[4].

Symptoms of, and further surgery for, adhesion formation as a result of surgery for compensable personal injury or for remediation of medically negligent acts should clearly be factored into quantum. Patient predisposition then becomes a "thin skull" proposition.

PRACTICE POINT

Symptoms and complications from Adhesions are factors of Quantum after both compensable personal injury and remedial surgery following medical negligence

Conversely, poor technique as a sole or contributory cause of surgical negligence is hard to prove. Excessive handling of the peritoneum, contamination with irritants such as surgical glove powder or spilled gallstones, inadequate irrigation of blood, pus and bowel contents may all contribute[5], but convincing clinical proof is exceptional.

Nevertheless, experimental evidence of suture material and glove-powder was found in nearly a quarter of patients[6] who underwent repeat laparotomy for a variety of reasons.

Adhesiolysis results in inadvertent enterotomy in up to 19% of subsequent surgeries[7]. Such enterotomies cause considerably greater morbidity and are one of the commonest causes[7a] of iatrogenic small bowel fistula formation[8 [full text],9].

The complex relationship between adhesions and chronic pelvic pain in women, and the potential benefits of adhesiolysis in this situation have been summarised[10]