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What Lies Beneath: Adhesion and Injury Risk in Laparoscopy after Abdominopelvic Surgery
Samantha S Mooney1, Hannah Gordon2, Debjyoti Karmakar1
1Department of Obstetrics Gynaecology and Newborn Health, University of Melbourne (Drs. Mooney, Gordon, Karmakar, Hicks, Readman), Parkville, Victoria, Australia; Department of Gynaecology, Mercy Hospital for Women (Drs. Mooney, Karmakar, Wong, Harlow, McNamara, Readman, Ellett, MIG Group), Heidelberg, Victoria, Australia.
Prior abdominopelvic surgery significantly increases umbilical adhesion risk, especially with multiple midline laparotomies. Predictive models can aid safer laparoscopic entry planning by assessing individual adhesion and injury risks.
Area of Science:
- Gynecologic surgery
- Minimally invasive procedures
- Surgical safety
Background:
- Adhesions from prior abdominopelvic surgery pose a risk of visceral injury during laparoscopic entry.
- Contemporary data on umbilical adhesion and visceral injury risk is limited.
Purpose of the Study:
- To quantify umbilical adhesion risk based on the number and type of prior surgeries.
- To assess the risk of visceral injury during umbilical entry.
- To develop predictive models for adhesion and injury risk.
Main Methods:
- Prospective cohort study of 823 patients undergoing elective gynecologic laparoscopy.
- Comparison between patients with and without prior abdominopelvic surgery.
- Documentation of adhesions, distance from umbilicus, and visceral involvement.
- Development and validation of logistic regression models for risk prediction.
Main Results:
- Adhesion risk increased significantly with prior surgery, from 7.6% (no prior surgery) to over 50% with ≥3 prior surgeries.
- Umbilical-risk adhesions rose from 0.7% to nearly 30% with ≥3 prior surgeries.
- Midline laparotomies, especially multiple ones, carried the highest adhesion risk (up to 100% overall, 60% umbilical-risk).
- Visceral injury was rare (0.49%) but associated with higher laparotomy burden.
- The developed umbilical-risk model showed good predictive performance (AUC 0.807).
Conclusions:
- The number and type of prior abdominopelvic surgeries, particularly multiple midline laparotomies, significantly elevate umbilical adhesion risk.
- History-based predictive models can enhance the safety and individualization of laparoscopic entry planning.
