Minimal-access colorectal surgery is associated with fewer adhesion-related admissions than open surgery

Background: This study aimed to describe national intermediate-term admission rates for incisional hernia or clinically apparent adhesions following colorectal surgery, and to compare rates following laparoscopic and open approaches. Methods: Patients undergoing primary colorectal resection between 2002 and 2008 were included from the Hospital Episode Statistics database. Subsequent inpatient admissions were extracted for up to 3 years after the initial operation or to the end of the study period. Outcomes examined were admissions with a diagnosis of, or operative interventions for, incisional hernia or adhesions. Results: A total of 187 148 patients were included between 2002 and 2008, with median follow-up of 31.8 (interquartile range 13.135.3) months. Some 8885 (4.7 per cent) of these patients were admitted with a diagnosis of, or underwent a repair of, an incisional hernia. In multiple regression analysis, use of laparoscopy was not a predictor of operative intervention for incisional hernia (odds ratio 1.09, 95 per cent confidence interval (c.i.) 0.99 to 1.21; P = 0.083). Some 15 125 (8.1 per cent) of the patients were admitted with a diagnosis of adhesions or had a procedure for division of adhesions. Overall, 3.5 per cent (6637 of 187 148) of patients underwent adhesiolysis. Patients selected for a laparoscopic procedure had lower rates of admission for adhesions (6.3 per cent (692 of 11 013) for laparoscopic versus 8.2 per cent (14 433 of 176 135) for open surgery; P < 0.001) and reintervention for adhesions (2.8 per cent (305 of 11 013) versus 3.6 per cent (6325 of 176 135) respectively; P < 0.001) than those undergoing an open procedure. In multiple regression analysis, patients selected for a laparoscopic procedure had lower subsequent intervention rates for adhesions (odds ratio 0.80, 95 per cent c.i. 0.71 to 0.90; P < 0.001). Discussion: Patients undergoing colorectal resection who are selected for the laparoscopic approach have a lower risk of developing clinically significant adhesions. Copyright (c) 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.