Guy Nash
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.
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