Adhesion awareness in 2016: An update of the national survey of surgeons
Sebastiaan van Steensel, Leontine C L van den Hil, Marc H F Schreinemacher, Richard P G Ten Broek, Harry van Goor, Nicole D Bouvy, Sebastiaan van Steensel, Leontine C L van den Hil, Marc H F Schreinemacher, Richard P G Ten Broek, Harry van Goor, Nicole D Bouvy
Abstract
Background and aims: Adhesions, that form in 60-80% of all abdominal operations, can cause complications such as chronic abdominal pain, small-bowel obstruction, female infertility, and the need for adhesiolysis in future surgeries. Our 2010 Adhesion Awareness survey demonstrated that despite the huge clinical impact of adhesions; adhesion-related complications were seldom mentioned in the informed consent. Six years later, a follow-up survey was conducted to assess the progress on awareness on adhesion-related complications in the Netherlands.
Material and methods: The 2010 Adhesion Awareness survey was repeated after a literature update. The knowledge regarding adhesions; the use of anti-adhesive agents and involvement in the informed consent process were assessed. Surgeons and surgical trainees were contacted by e-mail. The data was analysed using a Chi-square or Mann-Whitney U test and corrected for multiple testing.
Results: The response rate was 32.6%, similar to the survey in 2010 (34.4%). 88.1% agreed with the clinical relevance of adhesions, comparable to 2010 (89.8%). The score on the knowledge test was 38.8% (2010: 37.2%). Involvement of adhesion-related complications in the informed consent process increased, although 32.5% almost never mentions adhesions. In 2016, 42.4% reported a correct occurrence of bowel lesions during adhesiolysis, higher than in 2010 (P<0.001).
Conclusions: The adhesion awareness did not increase in six years, despite the efforts made. However, an increased awareness regarding adhesiolysis related complications was detected. Improvement of knowledge and behavior is essential to narrowing the gap between the impact of adhesions as a major complication of abdominal surgery and the limited adhesion awareness.
Conflict of interest statement
The authors have declared that no competing interests exist.
Figures
References
- Menzies D, Ellis H. Intestinal obstruction from adhesions—how big is the problem? Annals of the Royal College of Surgeons of England. 1990;72(1):60–3. Epub 1990/01/01. .
- Stommel MW, Ten Broek RP, Strik C, Slooter GD, Verhoef C, Grunhagen DJ, et al. Multicenter Observational Study of Adhesion Formation after Open-and Laparoscopic Surgery for Colorectal Cancer. Ann Surg. 2017. Epub 2017/02/17. 10.1097/SLA.0000000000002175 .
- ten Broek RP, Strik C, Issa Y, Bleichrodt RP, van Goor H. Adhesiolysis-related morbidity in abdominal surgery. Ann Surg. 2013;258(1):98–106. 10.1097/SLA.0b013e31826f4969 .
- Ellis H, Moran BJ, Thompson JN, Parker MC, Wilson MS, Menzies D, et al. Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet. 1999;353(9163):1476–80. 10.1016/S0140-6736(98)09337-4 .
- Parker MC, Ellis H, Moran BJ, Thompson JN, Wilson MS, Menzies D, et al. Postoperative adhesions: ten-year follow-up of 12,584 patients undergoing lower abdominal surgery. Dis Colon Rectum. 2001;44(6):822–29; discussion 9–30. .
- Rajab TK, Wallwiener M, Talukdar S, Kraemer B. Adhesion-related complications are common, but rarely discussed in preoperative consent: a multicenter study. World J Surg. 2009;33(4):748–50. 10.1007/s00268-008-9917-x .
- Schreinemacher MH, ten Broek RP, Bakkum EA, van Goor H, Bouvy ND. Adhesion awareness: a national survey of surgeons. World J Surg. 2010;34(12):2805–12. 10.1007/s00268-010-0778-8 .
- ten Broek RP, Stommel MW, Strik C, van Laarhoven CJ, Keus F, van Goor H. Benefits and harms of adhesion barriers for abdominal surgery: a systematic review and meta-analysis. Lancet. 2014;383(9911):48–59. 10.1016/S0140-6736(13)61687-6 .
- Vogels RRM, Kaufmann R, van den Hil LCL, van Steensel S, Schreinemacher MHF, Lange JF, et al. Critical overview of all available animal models for abdominal wall hernia research. Hernia. 2017. Epub 2017/05/04. 10.1007/s10029-017-1605-z .
- Parker MC, Wilson MS, Menzies D, Sunderland G, Clark DN, Knight AD, et al. The SCAR-3 study: 5-year adhesion-related readmission risk following lower abdominal surgical procedures. Colorectal disease: the official journal of the Association of Coloproctology of Great Britain and Ireland. 2005;7(6):551–8. Epub 2005/10/20. 10.1111/j.1463-1318.2005.00857.x .
- Johnson P, Richard C, Ravid A, Spencer L, Pinto E, Hanna M, et al. Female infertility after ileal pouch-anal anastomosis for ulcerative colitis. Dis Colon Rectum. 2004;47(7):1119–26. 10.1007/s10350-004-0570-7 .
- ten Broek RP, Bakkum EA, Laarhoven CJ, van Goor H. Epidemiology and Prevention of Postsurgical Adhesions Revisited. Ann Surg. 2016;263(1):12–9. 10.1097/SLA.0000000000001286 .
- Andersen P, Jensen KK, Erichsen R, Frøslev T, Krarup PM, Madsen MR, et al. Nationwide population-based cohort study to assess risk of surgery for adhesive small bowel obstruction following open or laparoscopic rectal cancer resection. BJS Open. 2017;1(2):30–8. 10.1002/bjs5.5
- Zinther NB, Fedder J, Friis-Andersen H. Noninvasive detection and mapping of intraabdominal adhesions: a review of the current literature. Surg Endosc. 2010;24(11):2681–6. 10.1007/s00464-010-1119-6 .
- Robb WB, Mariette C. Strategies in the prevention of the formation of postoperative adhesions in digestive surgery: a systematic review of the literature. Dis Colon Rectum. 2014;57(10):1228–40. 10.1097/DCR.0000000000000191 .
- De Wilde RL, Brolmann H, Koninckx PR, Lundorff P, Lower AM, Wattiez A, et al. Prevention of adhesions in gynaecological surgery: the 2012 European field guideline. Gynecol Surg. 2012;9(4):365–8. 10.1007/s10397-012-0764-2 .
- Meuleman T, Schreinemacher MH, van Goor H, Bakkum EA, Dorr PJ. Adhesion awareness: a nationwide survey of gynaecologists. European journal of obstetrics, gynecology, and reproductive biology. 2013;169(2):353–9. Epub 2013/05/01. 10.1016/j.ejogrb.2013.03.019 .
Source: PubMed