Adhesions: prevention and complications in general surgery

To document the incidence of adhesion-related problems and the current concepts on the prevention of adhesions among Swedish surgeons.

Postal questionnaire during 1992.

Sweden.

All surgical units performing abdominal surgery.

Number of patients admitted with or operated on for adhesive small bowel obstruction, methods in use to prevent the formation of adhesions, and costs of adhesion-related complications in abdominal surgery.

At least 4700 patients were admitted annually with symptoms of adhesive small bowel obstruction. Of these, 2200 were operated on to relieve the obstruction. No consistent methods were in use to minimise formation of adhesions. Surgical gloves were not washed before operation by 49 of the 84 units that replied and of those only 12 always used powder-free gloves, which gives a likelihood of starch contamination in 70%-82% of all operations. Only 13 (16%) of the units consistently avoided suturing the peritoneum separately. Yearly, at least 1500 laparotomies were complicated by previously formed adhesions. The annual medical expenditure for adhesive small bowel obstruction was more than US $6 million.

Postoperative adhesion formation created substantial morbidity and workload in surgical units. Efforts to reduce the formation of adhesions must be instituted. To start this process, the suturing of peritoneum and the use of powdered gloves could be omitted from clinical practice.