Impact of previous surgery on time taken for incision and division of adhesions during laparotomy

PURPOSE: Adhesions from previous surgery constitute amajor problem in general surgery. Much is known of the consequences of adhesions in terms of morbidity, but there has been Little documentation of the effect of previous surgery on the time taken to reoperate. METHODS: Information on incision time and division of adhesion time was recorded on 120 patients (89 elective cases and 31 emergencies) undergoing midline laparotomy under the care of a single colorectal surgeon. RESULTS: Fifty-one percent of elective and 71 percent of emergency cases had previously had abdominal surgery. Previous surgery prolonged the median incision time from 5 (range, 3-10) to 8 (range, 4-33) minutes (P < 0.001) and the median division of adhesion time from 0 (range, 0-30) to 15 (range, 0-12) minutes (P < 0.0001). CONCLUSIONS: Previous surgery significantly increases the operating time during subsequent surgery by a median of 18 minutes. This information may be of use in the planning of surgical workload and highlights the needs for cost-effective adhesion prevention strategies.