• A M Lower, R J Hawthorn, H Ellis, F O'Brien, S Buchan, and A M Crowe.
• Fertility Centre, St. Bartholomew's Hospital, London, UK.
• BJOG. 2000 Jul 1;107(7):855-62.

ObjectiveTo investigate the epidemiology of, and the clinical burden related to, adhesions following gynaecological surgery.PopulationThe Scottish National Health Service Medical Record Linkage Database was used to define a cohort of 8849 women undergoing open gynaecological surgery in 1986.MethodsAll readmissions for potential adhesion related disease in the subsequent 10 years were reviewed.Main Outcome MeasuresReadmissions and the degree of adhesion involvement gave an indication of clinical burden and workload. The rate of readmission following the initial surgery determined the relative risk of disease related to adhesions.ResultsTwo hundred and forty-five (4.5%) of 5433 readmissions following open gynaecological surgery were directly related to adhesions. 34.5% of patients were readmitted, on average 1.9 times, for a problem potentially related to adhesions or for further intra-abdominal surgery that could be complicated by adhesions. Readmissions related to adhesions continued throughout the 10 year period of the study. The overall rate of readmission was 64.0/100 initial operations. For readmissions directly related to adhesions, the rate was 2.9/100 initial operations. Operations on the ovary had the highest rate directly related to adhesions (7.5/100 initial operations), with an overall rate of readmission of 106.4/100 initial operations.ConclusionsDespite the conservative approach taken in this study, the clinical burden, workload and relative risk of readmissions related to adhesions following open gynaecological surgery was considerable. Post-operative adhesions have important consequences for patients, surgeons and the healthcare system. These results emphasise the need for more effective strategies to prevent adhesions.

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