Optimizing the Management of Adhesions Following Abdominal Surgery: A Prospective Study

Anotacija

Background. Adhesive-related abdominal surgery remains a chronic issue in the surgical field and a significant source of long-term patient morbidity. These fibrotic bands can result in complications such as: intestinal obstruction, chronic abdominal or pelvic pain, infertility, and repeat surgical procedure. Multiple preventive strategies have been suggested; however, their application in day-to-day clinical practice is variable and inadequately standardized. We looked at whether a structured and multidisciplinary protocol that they co-created with the Departments of General Surgery and Gynecology can reduce the incidence of adhesion-induced complications. Methods. We conducted a prospective trial of patients undergoing elective or emergency abdominopelvic procedures. There were two arms of the participants – regular care or advanced adhesion-control protocol. The protocol highlighted three central themes: 1) rigorous clinical practice and strict adherence to tissue-handling principles; 2) an algorithm-based selection and usage of adhesion-barrier materials; and 3) standard postoperative follow-up. The primary endpoint was the 12-month incidence of a composite outcome including all adhesion-related adverse events. Secondary endpoints were adhesive small-bowel obstruction (SBO), chronic abdominal pain, reoperation, length of hospital stay, and quality-of-life (QoL) scores. Results. 310 patients were assessed with 155 individuals in each group. The demographic and clinical baseline characteristics were similar. The primary outcome of the composite was significantly less frequently reported in the protocol group compared to routine-care group (18.1% vs. 35.5%; absolute reduction in risk = 17.4%; 95% CI 10.2–24.6; p < 0.001). Prominent improvements are also noted in secondary outcomes: adhesive SBO (7.7% vs. 20.0%; p < 0.001), chronic pain (18.1% vs. 34.8%; p < 0.001) and reoperation (3.9% vs. 12.3%; p < 0.001). The intervention group had significantly shorter mean hospital stay (4.2 days vs. 6.5 days; p = 0.01). At 12 months, QoL assessments revealed higher physical-component scores (75.1±7.8 vs. 60.2±8.5; p < 0.001) and mental-component scores (35.0±3.5 vs. 33.0±4.0; p = 0.03). Conclusion. A consistent, evidence based, multidisciplinary protocol for adhesion prevention decreases both the frequency and severity of postoperative adhesion and the related complications. The collaborative approach improves not only the patients’ quality of life, but also makes appropriate investment in health services, so as this can fit into ordinary surgical procedures.