Long-term impact of adhesions on bowel obstruction

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