BACKGROUND/AIMS: Adhesiolysis is a frequent part of colorectal surgery, potentially impeding the operation and causing inadvertent bowel injury. Such difficulties might compromise convalescence and oncological quality of resection. The aim of this prospective cohort study was to assess the impact of adhesiolysis on clinical outcomes and histopathological results in colorectal surgery. METHODS: Colorectal procedures were selected from a prospective cohort study of adhesiolysis-related problems. We compared the incidence of bowel injury, morbidity, costs, and the histopathology between patients undergoing elective colorectal surgery with or without adhesiolysis. RESULTS: Two hundred and forty nine colorectal surgeries were analysed. Adhesiolysis was required in 59.0%. The mean adhesiolysis time was 28 min. In the adhesiolysis group, enterotomies occurred in 6.1% and seromuscular injuries in 27.2% compared to 0 and 6.9% respectively in the non-adhesiolysis group (p = 0.012 and p < 0.001). In patients requiring adhesiolysis, 29.9% had major surgery-related complications (MSRC) compared to 15.7% without adhesiolysis (p = 0.007). There were no statistically significant differences regarding inpatient costs and resection margin or number of harvested lymph nodes. CONCLUSIONS: Adhesiolysis during colorectal surgery is related to an increased incidence of iatrogenic bowel injuries and MSRC. Despite the technical challenges associated with adhesiolysis, good histopathological results were obtained in oncological resections.
BACKGROUND/AIMS: Adhesiolysis is a frequent part of colorectal surgery, potentially impeding the operation and causing inadvertent bowel injury. Such difficulties might compromise convalescence and oncological quality of resection. The aim of this prospective cohort study was to assess the impact of adhesiolysis on clinical outcomes and histopathological results in colorectal surgery. METHODS: Colorectal procedures were selected from a prospective cohort study of adhesiolysis-related problems. We compared the incidence of bowel injury, morbidity, costs, and the histopathology between patients undergoing elective colorectal surgery with or without adhesiolysis. RESULTS: Two hundred and forty nine colorectal surgeries were analysed. Adhesiolysis was required in 59.0%. The mean adhesiolysis time was 28 min. In the adhesiolysis group, enterotomies occurred in 6.1% and seromuscular injuries in 27.2% compared to 0 and 6.9% respectively in the non-adhesiolysis group (p = 0.012 and p < 0.001). In patients requiring adhesiolysis, 29.9% had major surgery-related complications (MSRC) compared to 15.7% without adhesiolysis (p = 0.007). There were no statistically significant differences regarding inpatient costs and resection margin or number of harvested lymph nodes. CONCLUSIONS: Adhesiolysis during colorectal surgery is related to an increased incidence of iatrogenic bowel injuries and MSRC. Despite the technical challenges associated with adhesiolysis, good histopathological results were obtained in oncological resections.
Authors: Anwar Medellin Abueta; Nairo Javier Senejoa; Mauricio Pedraza Ciro; Lina Fory; Carlos Perez Rivera; Carlos Edmundo Martinez Jaramillo; Lina Maria Mateus Barbosa; Heinz Orlando Ibañez Varela; Javier A Carrera; Rafael Garcia Duperly; Luis A Sanchez; Ivan David Lozada-Martinez; Luis Felipe Cabrera-Vargas; Andres Mendoza; Paulo Cabrera; Sebastian Sanchez Ussa; Cristian Paez; Steven D Wexner; Victor Strassmann; Giovanna DaSilva; Salomone Di Saverio; Arianna Birindelli; Roberto Jose Rodríguez Florez; Abraham Kestenberg; Alexander Obando Rodallega; Juan Carlos Sánchez Robles; Carlos Adrian Niño Carrasco; Alessio Impagnatiello; Diletta Cassini; Gianandrea Baldazzi; Francesco Roscio; Gianluca Liotta; Pierluigi Marini; Daniel Gomez; Carlos Edgar Figueroa Avendaño; Daniela Moreno Villamizar; Laura Cabrera; Juan Carlos Reyes; Alexis Narvaez-Rojas Journal: Health Sci Rep Date: 2022-09-01