[Intra-abdominal adhesions and foreign-body granulomas following earlier laparotomy].

OBJECTIVE: To determine the prevalence of foreign body granulomas in intra-abdominal adhesions in patients subjected to relaparotomy. DESIGN: Cross-sectional. SETTING: University Hospital Rotterdam-Dijkzigt, the Netherlands. METHOD: From July 1991 to September 1992, 119 patients were subjected to relaparotomy. Presence, distribution and quality of adhesions were scored during the relaparotomy and adhesion samples were taken for histological examination. RESULTS: Adhesions were present in 94% of the patients; they were most frequently attached to small bowel (83%) and omentum (78%). The number of adhesions was significantly smaller in patients with a history of only one minor operation than in those with one major or multiple laparotomies. Foreign body granulomas were found in 22% of the patients with adhesions. These were caused by suture material (19%) or starch glove powder (6%); a combination of both occurred in 3% of the patients. When granulomas were present, the median interval between present and most recent laparotomy was significantly shorter than when no granulomas were found. In patients with adhesions who had had the previous operation less than 6 months previously, granulomas were present in 71%. In contrast, 13% of the patients operated upon longer than 6 months previously had granulomas. CONCLUSIONS: In young adhesions foreign body granulomas occur in large percentages of the cases. This suggests that the intra-abdominal presence of foreign material is an important cause of adhesion formation. Therefore, intra-abdominal contamination with suture material and glove powder should be avoided.