Lundorff et al developed risk scores for adhesions after gynecological surgery. One score is a preoperative 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
Parameters:
(1) previous abdominal or pelvis surgery
(2) history of post-surgical adhesions
(3) concomitant abdominal or gynecological inflammation and/or infection
(4) endometriosis
(5) cancer
(6) radiation therapy for intra-abdominal cancer
(7) keloid scarring
(8) intraperitoneal bleeding associated with previous operation
(9) postoperative complications after previous operation (fistula, abscess, etc)
(10) postoperative infection after previous surgery (including fever >= 38°C for >= 2 days)
Parameter |
Finding |
Points |
previous abdominal or pelvic surgery |
0 |
0 |
|
1 |
3 |
|
>= 2 |
4 |
history of post-surgical adhesions |
no |
0 |
|
yes |
4 |
concomitant abdominal or gynecological infection and/or inflammation |
no |
0 |
|
yes |
4 |
endometriosis |
none |
0 |
|
minimal |
1 |
|
mild |
2 |
|
moderate |
3 |
|
severe |
4 |
cancer |
none |
0 |
|
gynecological cancer |
2 |
|
peritoneal carcinomatosis |
2 |
|
local non-gynecological cancer |
3 |
|
metastatic cancer of extrapelvic origin |
2 |
radiation therapy for intra-abdominal cancer |
none |
0 |
|
to distant site |
1 |
|
intra-abdominal (local) |
4 |
keloid scarring |
no |
0 |
|
yes |
3 |
intraperitoneal bleeding |
unexpected drop of hemoglobin >= 2 g/dL |
2 |
|
unexpected drop in hemoglobin less than 2 g/dL |
0 |
|
none |
0 |
postoperative complications |
no |
0 |
|
yes |
4 |
postoperative infection |
no |
0 |
|
yes |
4 |
total score =
= SUM(points for all 10 parameters)
Interpretation:
• minimum score: 0
• maximum score: 36
• The higher the score the greater the risk of post-operative adhesions.
Total Score |
Risk of Adhesions |
0 to 12 |
low |
13 to 24 |
medium |
25 to 36 |
high |
Specialty: Gastroenterology