Impact of prior abdominal or pelvic surgery on colonoscopy outcomes

This large prospective study attempted to analyze the effect of various prior surgery on colonoscopy performance.

It is generally presumed that colonoscopy in patients with a history of abdominal or pelvic surgery is difficult. This difficulty is apparently due to adhesions and anatomic alterations after surgery but the incidence, site, and severity of adhesions are different according to the types of surgery.

We analyzed completion rate and insertion time in 4089 consecutive colonoscopies in patients with intact colon.

The adjusted completion rate for colonoscopy was 96.7%. The mean insertion time was 6.2+/-4.0 minutes. Not only old age [odds ratio (OR) 1.46; 95% confidence interval (CI) [1.04, 2.04]] and inadequate bowel cleansing (OR 5.82; 95% CI [4.19, 8.09]) but also a surgical history (OR 1.71; 95% CI [1.18, 2.48]) were independent factors associated with procedural incompleteness. Of surgical history, gastrectomy and hysterectomy were significantly associated with procedural incompleteness (P<0.001 and P=0.001, respectively). Old age (OR 1.48; 95% CI [1.22, 1.79]), female sex (OR 1.22; 95% CI [1.01, 1.48]), constipation as an indication (OR 1.58; 95% CI [1.24, 2.02]), and inadequate bowel cleansing (OR 1.46; 95% CI [1.13, 1.88]) were independent factors associated with prolonged insertion time (>10 min), but a surgical history lost statistical power as a predictor for prolonged insertion time in multivariate analysis.

Although the difference in insertion time was not substantial, a history of abdominal or pelvic surgery is associated with difficulty in colonoscopy.