Risk of late-onset adhesions and incisional hernia repairs after surgery

Abstract

Background: Long-term adhesion-related complications and incisional hernias after abdominal surgery are common and costly. There are few data on the risk of these complications after different abdominal operations.

Study design: We identified Medicare beneficiaries who underwent endovascular repair of an abdominal aortic aneurysm from 2001-2008 who presumably are not at risk for laparotomy-related complications. We identified all laparoscopic and open operations involving the abdomen, pelvis, or retroperitoneum and categorized them into 5 groups according to invasiveness. We then identified laparotomy-related complications for up to 5 years after the index operation and compared these with the baseline rate of complications in a control group of patients who did not undergo an abdominal operation.

Results: We studied 85,663 patients, 7,513 (8.8%) of which underwent a laparotomy, including 2,783 major abdominal operations, 709 minor abdominal operations, 963 ventral hernia repairs, 493 retroperitoneal/pelvic operations, and 2,565 laparoscopic operations. Mean age was 76.7 years and 82.0% were male. Major abdominal operations carried the highest risk for adhesion-related complications (14.3% and 25.0% at 2 and 5 years compared with 4.0% and 7.8% for the control group; p < 0.001) and incisional hernias (7.8% and 12.0% compared with 0.6% and 1.2% for the control group; p < 0.001). Laparoscopic operations (4.6% and 10.7% for adhesions, 1.9% and 3.2% for incisional hernias) carried the lowest risk.

Conclusions: Late-onset laparotomy-related complications are frequent and their risk extends through 5 years beyond the perioperative period. With the advancement and expansion of laparoscopic techniques and its attendant lower risk for long-term complications, these results can alter the risk-to-benefit profile of various types of abdominal operations and can also strengthen the rationale for additional development of laparoscopic approaches to abdominal operations.

Figure 1

Flow chart demonstrating the creation of the 5 laparotomy (LAP) groups and the control group. All patients enter the study 2 years before the date of their endovascular aneurysm repair (EVAR).

Figure 2

(A) Freedom from operative late-onset laparotomy-related adhesion complications (bowel resection or lysis of adhesions) in each of the 5 laparotomy (LAP) groups and the control group. Standard error does not exceed 10% for all survival curves. (B) Freedom from nonoperative late-onset laparotomy-related adhesion complications in each of the 5 LAP groups and the control group. X denotes where the standard error exceeds 10%, otherwise the standard error does not exceed 10% for all other survival curves. (C) Freedom from any late-onset laparotomy-related adhesion complications in each of the 5 LAP groups and the control group. X denotes where the standard error exceeds 10%, otherwise the standard error does not exceed 10% for all other survival curves. (D) Freedom from late-onset laparotomy-related incisional hernia repairs in each of the 5 LAP groups and the control group. X denotes where the standard error exceeds 10%, otherwise the standard error does not exceed 10% for all other survival curves. (E) Freedom from any surgery (bowel resection, lysis of adhesions, and incisional hernia repair) for late-onset laparotomy-related complications in each of the 5 LAP groups and the control group. X denotes where the standard error exceeds 10%, otherwise the standard error does not exceed 10% for all other survival curves. RP, retroperitoneum.