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J R Soc Med. 2001 October; 94(10): 555.
PMCID: PMC1282235

Attitudes to adhesion

Professor Ellis's review of the legal consequences of intra-abdominal adhesions (July 2001, JRSM pp. 331-332) was timely. We have been investigating surgeons' attitudes to this common problem. Though there is little clinical evidence, barrier agents such as Seprafilm have been shown experimentally to lessen adhesions without importantly reducing anastomotic strength1. Perhaps recent adverse events2 have caused some surgeons to abstain from using such agents.

Three points mentioned by Professor Ellis's article were included in a questionnaire sent online to our Forum for Registrars In Surgical Training (www.frist.org/temp/guynash.html ). General surgeons were asked whether they routinely warn patients, before laparotomy, of the risk of adhesions; whether they believe that covering a bowel anastomosis with omentum decreases the risk of future adhesions; and whether they use an agent, if available, in the hope of avoiding further adhesions in a patient with multiple previous laparotomies.

Of the 50 who replied initially, 7 routinely warn about adhesions, 12 favour omental covering and 25 would not currently use an agent such as Seprafilm. On the evidence of this small survey, the lack of consensus on aetiology and epidemiology extends to practical management.

References

1. Buckenmaier CC, Summers MA, Hetz SP. Effect of the antiadhesive treatments, carboxymethylcellulose combined with recombinant tissue plasminogen activator and Seprafilm, on bowel anastomosis in the rat. Am Surg 2000;66: 1041-5 [PubMed]
2. Trickett JP, Rainsbury RM, Green R. Paradoxical outcome after use of hyaluronate barrier to prevent intra-abdominal adhesions. J R Soc Med 2001;94(4): 183-4 [PMC free article] [PubMed]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press