Reoperation on the abdomen encased in adhesions

Purpose To determine outcome after lysis of intestinal adhesions, relief of obstruction, closure of fistulas and drainage of abscesses in patients with an abdominal cavity obliterated by chronic postoperative adhesions. Methods Among 40 patients with an abdomen encased in dense adhesions after a mean of 5 previous operations, 31 patients also had intestinal obstruction, 25 enteric fistulas and 20 abdominal abscesses. Reoperation was done and outcome assessed from the medical records and by a mailed questionnaire. Results Only 1 postoperative death occurred, but 24 early complications appeared. At hospital discharge, obstruction, fistula and abscess were completely resolved in all but 3 patients (P <0.001). Only 2 of 16 patients on parenteral nutrition before operation (TPN) still required it (P = 0.004). At late follow-up (mean, 4.6 years) the patients’ quality of life (mean score ± SD, 8.6 ± 2.1) was similar to that of a healthy control population (9.2 ± 1.2, P = 0.17). Conclusions: Reoperation on the abdomen encased in adhesions restores most patients to good health and an excellent long-term quality of life.