Adhesion barriers linked to complications in myomectomy, hysterectomy

LAS VEGAS – Adhesion barriers may cause more problems than they prevent when employed in myomectomy and hysterectomy.

Ileus, fever, hematomas, and even small bowel obstruction occurred significantly more often when the barriers were used in conjunction with those procedures – especially when performed as open surgeries, Dr. François Closon reported at the AAGL Global Congress. And although their use remains relatively small among these patients, it’s been steadily rising since 2003, he said.

“Adhesion barriers are also being used about eight times more often in myomectomies than in hysterectomies, and this seems to be going up every year,” Dr. Closon of McGill University, Montreal, said at the meeting sponsored by AAGL.

His retrospective study drew on the U.S. Healthcare Cost and Utilization Project Nationwide Inpatient Sample, and examined the perioperative outcomes of adhesion barriers among nearly 475,000 women who underwent myomectomy or hysterectomy during 2003-2011. Of these, 9,000 (about 2%) had an adhesion barrier applied during the surgery. There were no significant baseline differences between the groups, except for age. Women in the myomectomy group were younger than those in the hysterectomy group (mean 36 years vs. 46 years). Age, however, was not associated with the use of an adhesion barrier.

Dr. Closon found a significant linear increase in the use of barriers in both procedures over the study period. In hysterectomy, barrier use rose slightly, but significantly, from 0.37% in 2003 to 2% in 2011. The increase was much greater for use in myomectomy, which rose from 3% to 7% during the same period.

Ileus was significantly more common among myomectomies that used the barrier (4% vs. 3%; OR, 1.49). The difference was more pronounced with hysterectomies (5% vs. 2.5%; OR, 1.97).

Small bowel obstruction was rare, but significantly more common in hysterectomies that employed adhesion barriers (0.2% vs. 0.4%; OR, 1.89).

Fever was also significantly more common in both procedures when the barrier was used (myomectomy 4.4% vs. 3%; OR, 1.43; hysterectomy 2.5% vs. 1.6%; OR, 1.65).

“The odds of intra-abdominal hematoma, postoperative pain, and a length of stay of 3 or more days were also significantly higher when an adhesion barrier was applied,” Dr. Closon said.

He reported having no financial disclosures.

[email protected]

LAS VEGAS – Adhesion barriers may cause more problems than they prevent when employed in myomectomy and hysterectomy.

Ileus, fever, hematomas, and even small bowel obstruction occurred significantly more often when the barriers were used in conjunction with those procedures – especially when performed as open surgeries, Dr. François Closon reported at the AAGL Global Congress. And although their use remains relatively small among these patients, it’s been steadily rising since 2003, he said.

“Adhesion barriers are also being used about eight times more often in myomectomies than in hysterectomies, and this seems to be going up every year,” Dr. Closon of McGill University, Montreal, said at the meeting sponsored by AAGL.

His retrospective study drew on the U.S. Healthcare Cost and Utilization Project Nationwide Inpatient Sample, and examined the perioperative outcomes of adhesion barriers among nearly 475,000 women who underwent myomectomy or hysterectomy during 2003-2011. Of these, 9,000 (about 2%) had an adhesion barrier applied during the surgery. There were no significant baseline differences between the groups, except for age. Women in the myomectomy group were younger than those in the hysterectomy group (mean 36 years vs. 46 years). Age, however, was not associated with the use of an adhesion barrier.

Dr. Closon found a significant linear increase in the use of barriers in both procedures over the study period. In hysterectomy, barrier use rose slightly, but significantly, from 0.37% in 2003 to 2% in 2011. The increase was much greater for use in myomectomy, which rose from 3% to 7% during the same period.

Ileus was significantly more common among myomectomies that used the barrier (4% vs. 3%; OR, 1.49). The difference was more pronounced with hysterectomies (5% vs. 2.5%; OR, 1.97).

Small bowel obstruction was rare, but significantly more common in hysterectomies that employed adhesion barriers (0.2% vs. 0.4%; OR, 1.89).

Fever was also significantly more common in both procedures when the barrier was used (myomectomy 4.4% vs. 3%; OR, 1.43; hysterectomy 2.5% vs. 1.6%; OR, 1.65).

“The odds of intra-abdominal hematoma, postoperative pain, and a length of stay of 3 or more days were also significantly higher when an adhesion barrier was applied,” Dr. Closon said.

He reported having no financial disclosures.

[email protected]

LAS VEGAS – Adhesion barriers may cause more problems than they prevent when employed in myomectomy and hysterectomy.

Ileus, fever, hematomas, and even small bowel obstruction occurred significantly more often when the barriers were used in conjunction with those procedures – especially when performed as open surgeries, Dr. François Closon reported at the AAGL Global Congress. And although their use remains relatively small among these patients, it’s been steadily rising since 2003, he said.

“Adhesion barriers are also being used about eight times more often in myomectomies than in hysterectomies, and this seems to be going up every year,” Dr. Closon of McGill University, Montreal, said at the meeting sponsored by AAGL.

His retrospective study drew on the U.S. Healthcare Cost and Utilization Project Nationwide Inpatient Sample, and examined the perioperative outcomes of adhesion barriers among nearly 475,000 women who underwent myomectomy or hysterectomy during 2003-2011. Of these, 9,000 (about 2%) had an adhesion barrier applied during the surgery. There were no significant baseline differences between the groups, except for age. Women in the myomectomy group were younger than those in the hysterectomy group (mean 36 years vs. 46 years). Age, however, was not associated with the use of an adhesion barrier.

Dr. Closon found a significant linear increase in the use of barriers in both procedures over the study period. In hysterectomy, barrier use rose slightly, but significantly, from 0.37% in 2003 to 2% in 2011. The increase was much greater for use in myomectomy, which rose from 3% to 7% during the same period.

Ileus was significantly more common among myomectomies that used the barrier (4% vs. 3%; OR, 1.49). The difference was more pronounced with hysterectomies (5% vs. 2.5%; OR, 1.97).

Small bowel obstruction was rare, but significantly more common in hysterectomies that employed adhesion barriers (0.2% vs. 0.4%; OR, 1.89).

Fever was also significantly more common in both procedures when the barrier was used (myomectomy 4.4% vs. 3%; OR, 1.43; hysterectomy 2.5% vs. 1.6%; OR, 1.65).

“The odds of intra-abdominal hematoma, postoperative pain, and a length of stay of 3 or more days were also significantly higher when an adhesion barrier was applied,” Dr. Closon said.

He reported having no financial disclosures.

[email protected]