Medico-legal consequences of post-operative intra-abdominal adhesions.

Post-operative adhesions are an almost invariable consequence of abdominal or pelvic surgery, no matter whether this is performed by the open or laparoscopic technique. Their most important morbidity is small bowel obstruction, but other sequelae include female infertility and dyspareunia, and increased risk of visceral injury at any subsequent laparotomy or laparoscopy. Whether chronic abdominal pain is truly a consequence of adhesions is still a matter of some discussion, but it is likely to be accepted as an entity both by patients and by their legal advisors. While there is currently a scarcity of published literature on the subject, a recent assessment of adhesion-related medico-legal claims dealt with by the British medical defence associations has been undertaken. Successful medico-legal claims include cases of bowel perforation after laparoscopic division of adhesions, delays in the diagnosis of adhesion obstruction of the small bowel, infertility as a result of adhesions and 'pain'. This problem is unlikely to be unique to the UK alone and general practitioners, surgeons and gynaecologists worldwide need to be aware of the increasing burden of medico-legal claims arising from the complications of intra-abdominal adhesions. Most importantly they need to consider whether it is now timely to take steps to avoid them.