Lundorff et al developed risk scores for adhesions after gynecological surgery. One score is a perioperative assessment of risk. The authors are from multiple hospitals in Europe and the Anti-Adhesions in Gynaecology Expert Panel (ANGEL).
Patient selection: woman undergoing gynecological surgery
Parameter:
(1) quality of existing adhesions
(2) severity of existing adhesions
(3) bleeding
(4) procedure duration in minutes
(5) procedure complexity
(6) excessive coagulation > 2 square cm
(7) type and site of surgry
(8) intra-abdominal placement of mesh or other foreign body
(9) use of an electrical scalpel
(10) peritoneal closing
|
Parameter |
Finding |
Points |
|
quality of existing adhesions |
none |
0 |
|
|
filmy |
2 |
|
|
vascular |
3 |
|
|
dense |
4 |
|
severity of existing adhesions |
none |
0 |
|
|
single |
1 |
|
|
2 or 3 |
2 |
|
|
4 or more |
3 |
|
|
adhesions with bowel involvement |
4 |
|
bleeding |
none |
0 |
|
|
<= 500 mL |
0 |
|
|
> 500 |
4 |
|
duration |
< 90 minutes |
2 |
|
|
90 to 120 minutes |
3 |
|
|
> 120 minutes |
4 |
|
procedures |
not complex or extensive |
0 |
|
|
complex or extensive |
3 |
|
excessive coagulation |
no |
0 |
|
|
yes |
2 |
|
type and site of surgery |
laparoscopy, adhesiolysis from uterus |
3 |
|
|
laparoscopy, all other |
2 |
|
|
laparoscopy, fallopian tube |
1 |
|
|
open, fallopian tube |
2 |
|
|
open, ovary |
4 |
|
|
open, uterus |
3 |
|
intra-abdominal placement of foreign body |
no |
0 |
|
|
yes |
3 |
|
electrical scalpel |
no |
0 |
|
|
yes |
2 |
|
peritoneal closing |
no |
0 |
|
|
yes |
1 |
total score =
= SUM(points for all 10 parameter)
Interpretation:
• minimum score: 3
• maximum score: 31
• The higher the score the greater the risk of adhesions.
|
Total Score |
Risk |
|
3 to 17 |
low |
|
18 to 28 |
medium |
|
29 to 31 |
high |
Specialty: Gastroenterology
