Anterior abdominal wall adhesions after laparotomy or laparoscopy

Study Objective. To determine the frequency of postoperative adhesions to the anterior abdominal wall peritoneum that could affect sale placement of the initial laparoscopic umbilical cannula at subsequent procedures. Design. Prospective cohort study. Setting. Reproductive endocrinology and infertility service of a tertiary care referral hospital. Patients. Two hundred fifteen women, 124 with prior abdominal surgery and 91 with no prior surgery. Interventions. Surgical histories were reviewed, abdominal skin scars noted, and extent of anterior abdominal wall adhesions prospectively recorded. Statistical analysis was performed with the chi(2) test. Measurements and Main Results. No anterior abdominal wall adhesions were present in 91 patients with no previous surgery or 45 patients with previous laparoscopy (12 had more than 1 laparoscopy; p < 0.001 vs laparotomy). Seventeen (59%) of 29 patients with a midline vertical incision had anterior wall adhesions (p < 0.05 vs suprapubic transverse incision). Eleven (28%) of 39 with a suprapubic transverse incision had anterior wall adhesions (p < 0.001 vs no surgery or laparoscopy). Ninety-six percent of adhesions involved omentum and 29% included bowel. Conclusion. Prior laparotomy, whether through a midline vertical or suprapubic transverse incision, significantly increased the frequency of anterior abdominal wall adhesions, and these adhesions may complicate the placement of the laparoscopic cannula through the umbilicus.