Saturday, March 15, 2014
Correlation between scarring and adhesions - new study from the UK
Dr. Wiseman's picks: Another from Dr. Cheong in UK
Women who had undergone multiple previous operations and who had more than one abdominal scar, a palpable scar or a long scar were most likely to have adhesions. Women with the highest mean scar scores also had a greater total adhesion score.
P-583Can skin scar characteristics help predict the degree of pelvic adhesions at laparoscopy?
J.E. Glazebrook, L.J. Stocker and Y. Cheong
Southampton University, Faculty of Medicine, Southampton, United Kingdom
Study question Can individual or a combination of skin scar characteristics can predict the severity and extent of intra-abdominal adhesions?
Summary answer Women who had undergone multiple previous operations (p < 0.01) and who had more than one abdominal scar (p < 0.01), a palpable scar (p = 0.01) or a long scar (p = 0.03) were most likely to have adhesions. Women with the highest mean scar scores also had a greater total adhesion score (r = 0.400, p < 0.001).
What is known already Surgery is known to be a leading cause of abdomino-pelvic adhesions. One previous study reported that skin characteristics of a caesarean delivery scar correlated with the incidence and severity of intra-abdominal adhesions. Laparoscopic assessment of the pelvis provides a more accurate assessment of nature, extent and severity of pelvic adhesions. Similarities in the healing of the skin and peritoneum mean it may be possible to predict intra-abdominal adhesions by grading abdominal skin scar characteristics.
Study design, size, duration A prospective cohort study of N = 100 (adhesions formation from caesareans is 50%; α-error of 0.05 and β-error of 0.2, with the assumed rate of adhesions to be 35% in normal skin, compared with 65% in those with poor skin characteristics).
Participants/materials, setting, methods The study was conducted in a UK NHS tertiary referral centre. Women who had undergone previous abdomino-pelvic surgery and were undergoing elective laparoscopic gynaecological procedures were recruited pre-operatively. Abdominal scars were evaluated pre-operatively and adhesions were assessed intra-operatively using a validated skin scar questionnaire and adhesion scoring system.
Main results and the role of chance Of 100 women recruited into this study, 29 had no adhesions, 71 had adhesions. The nature of adhesions were filmy in 17 (24%), dense in 26 (37%) and cohesive in 28 (35%) women; extent was mild n = 25 (covering <26 26-50="" and="" area="" covering="" moderate="" n="20" of="" severe="" total="">51% of total area). Women who had undergone multiple previous operations (p < 0.01) and who had more than one abdominal scar (p < 0.01), a palpable scar (p = 0.01) or a long scar (p = 0.03) were most likely to have pelvic adhesions during the current surgery. Women with the highest mean scar scores also had a greater total adhesion score (r = 0.400, p < 0.001).26>
Limitations, reason for caution The patient population was predominantly white Caucasian, but darker skin is more commonly affected by abnormal scar patterns such as keloid. The subset of patients with abnormal healing may provide useful information as to the correlation between individual scarring difference and the prevalence of adhesions.
Wider implications of the findings Adhesion-related morbidity has major clinical and socioeconomic impact warranting proper patient counselling. Multiple previous operations, longer and more than one palpable skin scar are indicative of significant intra-abdominal adhesions.
Until now, there are no clinical tools to aid clinicians predict the degree of pelvic scarring prior to surgery. Accurate prediction of pelvic adhesions could facilitate surgical decision-making and augment informed patient choice.
Further research is needed to establish how this information can be applied clinically.
Study funding/competing interest(s) The authors declare s. No funding was involved in this study.