"What Lies Beneath": Keyhole surgery after previous abdomino-pelvic surgery, and the risk of developing important scar tissue.

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We aim to complete a prospective observational cohort study to examine the rates of intra-abdominal adhesions in women with a past history of abdomino-pelvic surgery undergoing laparoscopy for any indication at our institution. At time of consent for laparoscopy for any indication, patients will be invited to participate in this study. Our study has a pragmatic design, and patient involvement in the research will not alter their treatment course. Upon consent and enrolment, the research team will then endeavour to obtain operative notes from prior surgeries for each study subject. Data will then be entered into a secure database, noting baseline patient characteristics, year of prior surgery(ies), type and number of prior incision(s), and any known history of complications during/after the prior abdominal surgeries. Patient confidentiality will be respected as per HREC guidelines. Collection of baseline data (including prior operative history) will occur pre-operatively at time of consent to participation and upon wait-listing of the case. Intra-operative findings will be documented during the planned procedure (by way of intraoperative clinical pictures), as well as at the by completion of a brief questionnaire at the conclusion of the procedure. This questionnaire will concern the presence/absence of anterior abdominal wall adhesions, their proximity to the umbilicus, and whether omentum, bowel, or both were involved. The questionnaire will take 5 minutes. Results will be analysed following the completion of data collection (once the final enrolled participant has undergone their planned surgery). Any surgical complications will be noted either on the operative questionnaire (for immediate complications), or at the initial 1-2 month post-operative visit (for delayed complications).

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