Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomized, double-blind multicenter study. Detection of abdominal wall adhesions using visceral slide Influence of small intestinal serosal defect closure on leakage rate and adhesion formation: a pilot study using rabbit models Reduction in Adhesive Small-Bowel Obstruction by Seprafilm® Adhesion Barrier After Intestinal Resection [Peritoneal suture vs. non-suture at caesarean section]. Detection of abdominal adhesions in laparoscopic surgery. A controlled study of 130 cases. Adhesion formation after microlaparoscopic and laparoscopic ovarian coagulation for polycystic ovary disease. Role of microlaparoscopy in the diagnosis of peritoneal and visceral adhesions and in the prevention of bowel injury associated with blind trocar insertion. Adhesion formation after laparoscopic surgery in tubal pregnancy: a randomized trial versus laparotomy. Adhesion formation after laparoscopic ovarian cautery for polycystic ovarian syndrome: lack of correlation with pregnancy rate. Non-closure versus closure of peritoneum during cesarean section: a randomized study. Visceral Sliding Technique Is Useful for Detecting Abdominal Adhesion and Preventing Laparoscopic Surgical Complications Intraperitoneal treatment of incisional and umbilical hernias using an innovative composite mesh: four-year results of a prospective multicenter clinical trial Gonadotrophin-releasing hormones agonist therapy increases peritoneal fibrinolytic activity and prevents adhesion formation after myomectomy Chance of adhesion formation after laparoscopic salpingo-ovariolysis: is there a place for second-look laparoscopy? Prevention of Postoperative Abdominal Adhesions by a Novel, Glycerol/Sodium Hyaluronate/Carboxymethylcellulose-Based Bioresorbable Membrane: A Prospective, Randomized, Evaluator-Blinded Multicenter Study Anterior abdominal wall adhesions after laparotomy or laparoscopy.
BACKGROUND Postoperative abdominal adhesions are associated with numerous complications , including small bowel obstruction , difficult and dangerous reoperations , and infertility . A sodium hyaluronate and carboxymethylcellulose bioresorbable membrane ( HA membrane ) was developed to reduce formation of postoperative adhesions . The objectives of our prospect i ve study were to assess the incidence of adhesions that recurred after a st and ardized major abdominal operation using direct laparoscopic peritoneal imaging and to determine the safety and effectiveness of HA membrane in preventing postoperative adhesions . STUDY DESIGN Eleven centers enrolled 183 patients with ulcerative colitis or familial polyposis who were scheduled for colectomy and ileal pouch-anal anastomosis with diverting-loop ileostomy .  Before abdominal closure , patients were r and omly assigned to receive or not receive HA membrane placed under the midline incision . At ileostomy closure eight to 12 weeks later , laparoscopy was used to evaluate the incidence , extent , and severity of adhesion formation to the midline incision . RESULTS Data were analyzed for 175 assessable patients . While only five ( 6 percent ) of 90 control patients had no adhesions , 43 ( 51 percent ) of 85 patients receiving HA membrane were free of adhesions ( p < 0.00000000001 ) . The mean percent of the incision length involved was 63 percent in the control group , significantly greater than the 23 percent observed in patients who received HA membrane ( p < 0.001 ) . Dense adhesions were observed in 52 ( 58 percent ) of the 90 control patients , but in only 13 ( 15 percent ) of the 85 receiving HA membrane ( P < 0.0001 ) . Comparison of the incidence of specific adverse events between the groups did not identify a difference ( P > 0.05 ) . CONCLUSIONS This study represents the first controlled , prospect i ve evaluation of postoperative abdominal adhesion formation and prevention after general abdominal surgery using st and ardized , direct peritoneal visualization . In this study , HA membrane was safe and significantly reduced the incidence , extent , and severity of postoperative abdominal adhesions Background Abdominal surgery , peritonitis , and pelvic inflammatory disease often give rise to intra-abdominal adhesions . They may lead to chronic pain , infertility , bowel obstruction , etc . Development in surgical strategies in the last decade has result ed in an increase in laparoscopic procedures and , as a consequence , a steep rise in reported bowel lesions . Accordingly , noninvasive diagnostic tools are desirable to identify adhesions before abdominal surgery . This study was design ed to vali date transabdominal ultrasonography ( TAU ) and magnetic resonance imaging ( cine MRI ) for detection of abdominal wall adhesions . Methods Sixty patients scheduled for laparoscopic surgery were prospect ively enrolled . They were divided into two groups of 30 each ; previous abdominal surgery/peritonitis and no history of abdominal surgery/peritonitis . Before elective surgery , TAU and cine MRI were performed . Visceral slide was measured in nine predefined abdominal segments and compared with intra-operative data on abdominal wall adhesions . Results were obtained in a double-blinded fashion . Results Patient characteristics were similar in both groups . Cine MRI showed a sensitivity , specificity , and accuracy of 21.5 % , 87.1 % , and 72.4 % . TAU showed a sensitivity , specificity , and accuracy of 24 % , 97.9 % , and 81.3 % . Comparison of TAU and cine MRI showed no significant difference in the detection of adhesions to the abdominal wall ; however , TAU was significantly superior in depicting adhesion-free areas . Conclusions This study represents the first comparative study of TAU and cine MRI as noninvasive methods in detecting adhesions to the abdominal wall . Both methods are specific in detecting adhesion-free areas , and may serve as a diagnostic tool for future planning of laparoscopic surgery , elucidation of adhesion-related symptoms , and as a tool in the follow-up after ventral hernia repair with implantation of intraperitoneal mesh Background The management of small intestinal serosal defects remains controversial . Non-closure of such defects is regarded as a risk factor of fistula formation or intestinal leakage , whereas defect closure with absorbable suture material is potentially associated with adhesion formation . The aim of our pilot study was to evaluate the influence of small intestinal serosal defect closure on peritoneal wound healing , leakage rate , and adhesion formation in a rabbit model . Methods Twenty-two male rabbits were r and omized into two groups . Following median laparotomy , a st and ardized small intestinal serosal defect with a diameter of 1 cm was performed . Either the defect was closed by two seromuscular 4/0 polyglactin single sutures ( n = 11 ) or the defect was left open ( n = 11 ) . On postoperative day 14 , all animals were sacrificed for morphological investigations . Complications and the rate of intestinal leakage were measured . The degree of adhesion formation was measured by computer-assisted planimetry . Results No animal developed fistula formation or intestinal leakage . Eight ( 73 % ) animals of the closure group developed local peritoneal adhesions with a mean size of 39.7 ± 45 mm2 . No animal in the non-closure group revealed local peritoneal adhesions at the defect . However , two ( 18 % ) animals in the non-closure group developed peritoneal adhesions distant to the defect with a mean size of 3.5 ± 9 mm2 . Comparing both groups , the size of peritoneal adhesions was significantly higher in the closure group ( p = 0.013 ) . Conclusions Closure of isolated serosal injuries with resorbable suture material was associated with an adhesion formation in distressing certainty , whereas no leakage or fistula formation could be observed at all . Further studies are needed to clarify the impact of serosal defect closure in particular on leakage rate and fistula formation , e.g. , with pre-existing adhesions , in case of multiple serosal injuries or with a pre-existing peritonitis Introduction Although Seprafilm ® has been demonstrated to reduce adhesion formation , it is not known whether its usage would translate into a reduction in adhesive small-bowel obstruction . Methods This was a prospect i ve , r and omized , multicenter , multinational , single-blind , controlled study . This report focuses on those patients who underwent intestinal resection ( n = 1,701 ) . Before closure of the abdomen , patients were r and omized to receive Seprafilm ® or no treatment . Seprafilm ® was applied to adhesiogenic tissues throughout the abdomen . The incidence and type of bowel obstruction was compared between the two groups . Time to first adhesive small-bowel obstruction was compared during the course of the study by using survival analysis methods . The mean follow-up time for the occurrence of adhesive small-bowel obstruction was 3.5 years . Results There was no difference between the treatment and control group in overall rate of bowel obstruction . The incidence of adhesive small-bowel obstruction requiring reoperation was significantly lower for Seprafilm ® patients compared with no-treatment patients : 1.8 vs. 3.4 percent ( P < 0.05 ) . This finding represents an absolute reduction in adhesive small-bowel obstruction requiring reoperation of 1.6 percent and a relative reduction of 47 percent . In addition , a stepwise multivariate analysis indicated that the use of Seprafilm ® was the only predictive factor for reducing adhesive small-bowel obstruction requiring reoperation . In both groups , 50 percent of first adhesive small-bowel obstruction episodes occurred within 6 months after the initial surgery with nearly 30 percent occurring within the first 30 days . Additionally no first adhesive small-bowel obstruction events were reported in Years 4 and 5 of follow-up . Conclusions The overall bowel obstruction rate was unchanged ; however , adhesive small-bowel obstruction requiring reoperation was significantly reduced by the use of Seprafilm ® , which was the only factor that predicted this outcome UNLABELLED To assess intraoperative , early and late postoperative morbidity followings non-closure of parietal and visceral peritoneum during caesarean section as compared to usual peritonization .  Two groups of 40 pregnant women each were r and omized to either closure ( n = 40 ) or non closure ( n = 40 ) . Statistical analysis compared intraoperative and postoperative outcome between the two groups . RESULTS There was significant reduction in operating and anesthesia time , febrile morbidity , return of bowel function and period of hospitalization among the non closure group . Peritoneal adhesions and upward displacement of bladder were more frequently noted during a subsequent caesarean in the closure group . Non closure of the peritoneum during caesarean section is a shorter , simpler , cost effective procedure associated with lesser febrile morbidity and hospitalization , early return of bowel function , reduced frequency of the postoperative adhesions and upward displacement of bladder The risk of visceral injury during laparoscopy occurs mainly during the creation of the pneumoperitoneum and the insertion of the first trocar and is substantially greater in patients with a previous history of laparotomic surgery or peritonitis , owing to the possible presence of abdominal wall adhesions . In this study we assessed the results of preoperative ultrasonography of the parietal wall for the diagnosis of peritoneal adhesions , through the detection of two signs unrelated to one another , for the purpose of minimizing the number of false-negative results . Ultrasonography of the parietal wall was performed preoperatively in 130 patients who had previously undergone laparotomy .  The ultrasound results were transcribed in the form of a map of the abdominal wall and checked during laparoscopy . The overall diagnostic accuracy was 88.5 % , the specificity was 31.8 % , and the sensitivity was 100 % . The hazardous laparoscopic maneuvers were performed in adhesion-free areas in all cases , and there were no cases of complications due to visceral injury STUDY OBJECTIVE To compare the effects of microlaparoscopy and decreased CO2 exposure on peritoneal microcirculation and potential adhesion formation  after ovarian surgery with those of conventional operative laparoscopy . DESIGN Prospect i ve , r and omized study ( Canadian Task Force classification I ) . SETTING Teaching hospital . PATIENTS Eighteen women with polycystic ovary disease . INTERVENTIONS Microlaparoscopic or laparoscopic ovarian coagulation of the ovaries . MEASUREMENTS AND MAIN RESULTS Approximately 10 to 12 coagulation points were applied to each ovary . Two to 3 weeks after the initial surgery second-look microlaparoscopy was performed to determine the extent of adhesions in both groups . The frequency of adhesion formation and changes in glutathione peroxidase ( GSH-Px ) , superoxide dismutase ( SOD ) , catalase ( CAT ) , and glutathione ( GSH ) levels were studied in homogenized peritoneal tissues obtained during surgery in each group . RESULTS Clinical profiles were similar between groups . Mean exposure , amount , and pressure of CO2 were significantly less in the microlaparoscopy group ( p < 0.05 ) . The laparoscopy group had significantly more adhesions than the microlaproscopy group ( 24 % vs 48 % , p < 0.05 ) . The GSH-Px , SOD , CAT , and GSH levels were significantly lower in the laparoscopy group ( 0 . 425 micromol , 1.2 ng , 37.55 micromol , and 0.9 nmol vs 0.755 micromol , 2.l ng , 625 micromol , and 2.6 nmol , respectively ) . CONCLUSION Reduced exposure to and amount of CO2 during microlaparoscopy may result in decreased adhesion formation compared with conventional laparoscopy . This effect may possibly be due to lack of or minimal adverse effects on peritoneal microcirculation and cell-protective systems , which are proposed mechanisms for adhesion formation and closely related to peritoneal injury . In addition , microlaparoscopy may be a cost-effective alternative to conventional laparoscopy . ( J Am Assoc Gynecol Laparosc 6(2):159 - 163 , 1999 OBJECTIVE To determine the frequency of peritoneal and visceral adhesions to the umbilical region according to past surgical history and to estimate the risk of bowel injury with blind insertion of the principal trocar-cannula . DESIGN Prospect i ve , unicentric study by a single operator . SETTING Clinique Saint-Sernin and Polyclinique de Bordeaux , Bordeaux , France . PATIENT(S ) Eight hundred fourteen patients undergoing diagnostic or operative laparoscopy were classified into four groups based on their history of abdominal surgery : group I ( n = 469 ) , no previous abdominal surgery ; group II ( n = 125 ) , prior laparoscopic surgery ; group III ( n = 131 ) , previous laparotomy with a horizontal supra-pubic incision ; group IV ( n = 89 ) , previous laparotomy with a midline incision .  INTERVENTION(S ) Initial microlaparoscopy performed through the left upper quadrant of the abdomen , inspection of the anterior abdominal wall and particularly the umbilical area for the presence of adhesions . Patients who had adhesions were assessed as to whether or not they were at significant risk of injury from blind insertion of the principal trocar . MAIN OUTCOME MEASURE(S ) Incidence of umbilical adhesions and the potential risk of bowel injury with blind  insertion of the umbilical ( principal ) trocar . RESULT ( S ) Umbilical adhesions were found in 9.82 % of the 814 cases . The rates of umbilical adhesions were as follows : group I , 0.68 % ; group II , 1.6 % ; group III , 19.8 % ; and group IV , 51.7 % . Severe adhesions with potential risk of bowel injury with blind insertion of the umbilical trocar in the four groups were 0.42 % , 0.80 % , 6.87 % , and 31.46 % , respectively . CONCLUSION ( S ) Women with previous laparotomy have a higher incidence of umbilical adhesions , especially in case of midline incision . Preliminary inspection of the umbilical area with a microlaparoscope and insertion of the umbilical trocar under direct vision are recommended for patients at risk for adhesions to reduce complications associated with insertion of the principal ( umbilical ) trocar OBJECTIVE Women with ectopic pregnancy ( EP ) who have been operated on by laparoscopy  are thought to have improved subsequent fertility , probably because of less adhesion formation . We aim ed to evaluate the adhesion formation after laparoscopy as compared with laparotomy in a r and omized trial . DESIGN One hundred five patients with tubal pregnancy were stratified with regard to age and risk factors and r and omized to surgery by laparoscopy or laparotomy . To evaluate adhesion formation and tubal status , 73 patients with strong desire of pregnancy underwent a second-look laparoscopy . The adhesion status at the ipsilateral and contralateral side at primary surgery was compared with the status at second-look laparoscopy . RESULTS Patients operated on by laparotomy developed significantly more adhesions at the operated side than patients operated on by laparoscopy ( P less than 0.001 ) . Substantially more patients in the laparotomy group underwent adhesiolysis at second-look laparoscopy than did patients in the laparoscopy group . Tubal patency did not differ between the groups . CONCLUSIONS Laparoscopic treatment of EP results in less impairment of the pelvic status compared with conventional conservative surgery OBJECTIVE To assess adhesion formation after laparoscopic ovarian cautery in women with polycystic ovarian syndrome ( PCOS ) and the efficacy of Interceed Adhesion Barrier ( Ethicon , Summerville , NJ ) in their prevention . DESIGN Prospect i ve , r and omized , blinded , clinical study of laparoscopic ovarian cautery with application of Interceed to one ovary , followed by short interval second-look laparoscopy , scoring of adhesions , and clinical follow-up . SETTING Tertiary care clinic at a University teaching hospital . PATIENTS Eight infertile women with PCOS who failed to conceive with previous clomiphene citrate ( CC ) therapy .  RESULTS Periovarian adhesions of varying severity developed in all women after laparoscopic ovarian cautery . Interceed showed no protective effect . Despite this finding , all women initiated regular menses after laparoscopic ovarian cautery and seven of eight women spontaneously conceived eight singleton pregnancies without any further therapy . CONCLUSION Laparoscopic ovarian cautery should be considered in infertile women with PCOS who fail to respond to CC therapy . These women must be counseled with respect to the possible complication of postoperative adhesion formation BACKGROUND Adhesion b and s are reported to be among the most common complications of gynecological surgery procedures . The aim of this study was to compare the frequency of post-surgical adhesion among patients with closed or open peritoneal repair  in the subsequent cesarean sections . METHODS A prospect i ve r and omized trial was performed on 45 patients who underwent cesarean section during a 5-year period . Among these patients , 24 patients were operated on by closure of the peritoneum  and 21 patients were operated on by the non-closure method .  Overall , 31 patients had a second pregnancy and cesarean section within the time of the study . These patients were evaluated to determine if they had any adhesion between the omentum and abdominal wall or uterus or between the uterus and abdominal wall or rectus muscle . RESULTS The two groups were similar to each other with regard to the causes of cesarean section . Seven cases of adhesions were diagnosed during subsequent cesarean sections among 13 patients ( 54 % ) with peritoneal non-closure , compared with 3 in 18 women ( 15 % ) with peritoneal closure ( relative risk : 3.2 ; 95 % confidence interval : 1.0 - 10.2 ) . CONCLUSION Closure of the peritoneum increases the operating time , but may decrease the risk of adhesions . The results of this study suggest that , during cesarean section , suture of the peritoneum may be a better option than leaving it unsutured Study Objective : Introduce a non-invasive method preoperatively to prevent bowel injury by the Veres needle and trocar during laparoscopy . Design : Case-controlled study . Setting : A hospital-based study . Patients : Five hundred and twelve patients who underwent laparoscopic surgery were prospect ively enrolled . Intervention : A simple and non-invasive method to detect bowel adhesions preoperatively . Results : A total of 512 patients who underwent operative laparoscopy  were prospect ively enrolled for ultrasonographic visceral sliding evaluation . They were subdivided into two groups as follows : group I , 332 patients without previous abdominal surgery ; group II , 180 patients with previous abdominal surgery .  No bowel adhesion to the umbilicus was present in group I. In group II , only two cases with bowel adhered to the periumbilical area were found by visceral sliding technique . No patients suffered any bowel injury . Conclusion : The proposed technique is useful and highly effective in guiding the insertion of the Veres needle and trocar to prevent bowel injury in laparoscopy Intraperitoneal positioning of conventional parietal mesh provides efficient reconstruction but causes visceral adhesion formation in 80–100 % of the cases . The purpose of this clinical trial was to assess the performance and tolerance of a new generation of polyester mesh protected by a hydrophilic resorbable film . Eighty patients were included in a prospect i ve multicenter clinical trial . Patients were treated for ventral hernia via an open approach ( 64 % ) or laparoscopically ( 36 % ) . All meshes were implanted in a midline intraperitoneal location . The main objective was to evaluate the anti-adhesive capability of the mesh in relation to the viscera . In order to assess the absence of visceral adhesion objective ly , an ultrasound ( US ) specific examination was initially vali date d ( pre-operative prediction vs. per-operative findings ) and then used during the follow-up . The usual clinical parameters were also collected to follow the patients on a period up to 4 years . Pre-operative US prediction vs. per-operative macroscopic findings : sensitivity 79 % , overall accuracy 76 % , negative predictive value 85 % . After 12 months , 86 % of the patients were ultrasonically adhesion free . Early post-operative complications were : seroma/hematoma ( 16 % ) , subcutaneous infection ( 4 % ) , cutaneous necrosis ( 1 % ) and occlusions ( outside the mesh ) ( 2.5 % ) . No mortality was reported . Clinical ly , after 12-month follow-up , no complication related to post-operative adhesions to the mesh was noted : ( occlusion 0 % , fistula 0 % ) . Late complications were : mesh sepsis ( 1 % ) , new defects ( 4 % ) and recurrence ( 2.5 % ) . Finally , 56 patients ( 75.7 % ) were clinical ly evaluated with a mean follow-up of 48±6 months . One direct recurrence was noted while six patients experienced new defect outside the mesh . No long-term severe complication such as occlusion or enterocutaneous fistula was observed . Based on a mean clinical follow-up of 4 years , the results of this prospect i ve multicenter clinical trial demonstrate the safety and the efficiency of this composite mesh in the intraperitoneal treatment of incisional and umbilical hernia . In particular there was no early or long-term main complication due to the intraperitoneal location of the mesh The aim of this study was to evaluate uterine adhesions after  myomectomy  and peritoneal fibrinolytic capacity in women treated with gonadotrophin-releasing hormone agonist ( GnRHa ) before surgery . A prospect i ve observational study comprised 15 infertile women who underwent myomectomy .  Before surgery , 10 were treated with buserelin acetate ( 900 μg/day ) for 10 – 12 weeks followed by additional postoperative treatment with GnRHa for 4 weeks ( GnRHa group ) and five received no treatment ( control group ) . Peritoneal fluid specimens were taken at the beginning of myomectomy and the adhesions were estimated by second-look surgery ( caesarean section or laparoscopy ) . Levels of plasminogen activator ( PA ) and PA inhibitor ( PAI ) were determined by enzyme-immunosorbent assays . Pre- and postoperative GnRHa therapy significantly reduced adhesion formation compared with control groups ( adhesion scores ; 0.2 ± 0.4 vs. 2 ± 1 , P < 0.0001 ) . GnRHa group showed a significant decrease in PAI level ( P < 0.0001 ) but no significant change in PA level , suggesting increased fibrinolytic capacity in peritoneal fluid from GnRHa-treated patients . These data suggest that GnRHa therapy is successful in preventing adhesion formation after myomectomy . GnRHa-induced shift to more fibrinolytic activity , mainly because of a decreased level of PAI , may play a critical role in the mechanism of the GnRHa 's action on postoperative adhesion development STUDY OBJECTIVE To evaluate the chance of adhesion formation after  laparoscopic salpingo-ovariolysis  and determine the efficacy of early second-look laparoscopy ( SLL ) . DESIGN Prospect i ve , r and omized study ( Canadian Task Force classification I ) . SETTING Shiraz University hospitals . SUBJECT Ninety women with mean duration of infertility of 7.2 years . INTERVENTIONS Operative laparoscopy , with early SLL with adhesiolysis in 46 ( group 1 ) and no SLL in 44 women ( group 2 ) . MEASUREMENTS AND MAIN RESULTS Adnexal adhesions were evaluated according to American Society for Reproductive Medicine adhesion classification . Separation of newly reformed adhesions was performed at the time of SLL . Patients were followed for a year after operation without other infertility treatment . At the time of operation in group 1 , adnexal adhesions were grade d as severe ( class D ) in 19 women , moderate ( class C ) in 31 , mild ( class B ) in 28 , and minimal ( class A ) in 14 . Respective figures in group 2 were 10 , 30 , 34 , and 14 . After salpingo-ovariolysis these figures were 12 , 10 , 20 , and 50 in group 1 and 6 , 14 , 17 , and 51 in group 2 . In group 1 in whom early second-look laparoscopy was performed , at the start of the operation these figures were 17 , 20 , 21 , and 34 , and after operation 12 , 8 , 20 , and 52 , respectively . There were 11 term pregnancies in group 1 and 15 in group 2 . No women with severe adhesions in either group conceived . In group 1 , chances of term pregnancy were 18.75 % for those with moderate adhesions , 35.71 % for women with mild adhesions , and 42.86 % in patients with minimal adhesions . Respective figures in group 2 were 26.67 % , 41.18 % , and 57.14 % . CONCLUSION The chance of moderate and severe adhesion reformation after laparoscopic salpingo-ovariolysis was 40.2 % . Although separation of these adhesions could be performed more easily at the time of early SLL , the chance of pregnancy did not increase compared with that in patients who did not undergo SLL INTRODUCTION Postoperative abdominal adhesions are associated with significant morbidity and mortality , placing a substantial burden on healthcare systems worldwide . Development of a bioresorbable membrane containing up to 23 percent glycerol and chemically modified sodium hyaluronate/carboxymethylcellulose offers ease of h and ling and has been shown to provide significant postoperative adhesion prevention in animals . This study was design ed to assess the safety of glycerol hyaluronate/carboxymethylcellulose and to evaluate its efficacy in reducing the incidence , extent , and severity of postoperative adhesion development in surgical patients . METHODS Twelve centers enrolled 120 patients with ulcerative colitis or familial polyposis who were scheduled for a restorative proctocolectomy and ileal pouch-anal anastomosis with diverting loop ileostomy . Before surgical closure , patients were r and omized to no antiadhesion treatment ( control ) or treatment with glycerol hyaluronate/carboxymethylcellulose membrane under the midline incision . At ileostomy closure , laparoscopy was used to evaluate the incidence , extent , and severity of adhesion formation to the midline incision . RESULTS Data were analyzed using the intent-to-treat population . Treatment with glycerol hyaluronate/carboxymethylcellulose result ed in 19 of 58 patients ( 33 percent ) with no adhesions compared with 6 of 60 adhesion-free patients ( 10 percent ) in the no treatment control group ( P = 0.002 ) . The mean extent of postoperative adhesions to the midline incision was significantly lower among patients treated with glycerol hyaluronate/carboxymethylcellulose compared with patients in the control group ( P < 0.001 ) . The severity of postoperative adhesions to the midline incision was significantly less with glycerol hyaluronate/carboxymethylcellulose than with control ( P < 0.001 ) . Adverse events were similar between treatment and no treatment control groups with the exception of abscess and incisional wound complications were more frequently observed with glycerol hyaluronate/carboxymethylcellulose . CONCLUSIONS Glycerol hyaluronate/carboxymethylcellulose was shown to effectively reduce adhesions to the midline incision and adhesions between the omentum and small bowel after abdominal surgery . Safety profiles for the treatment and no treatment control groups were similar with the exception of more infection complications associated with glycerol hyaluronate/carboxymethylcellulose use . Animal models did not predict these complications STUDY OBJECTIVE To determine the frequency of postoperative adhesions to the anterior abdominal wall peritoneum that could affect safe placement of the initial laparoscopic umbilical cannula at subsequent procedures . DESIGN Prospect i ve cohort study . SETTING Reproductive endocrinology and infertility service of a tertiary care referral hospital . PATIENTS Two hundred fifteen women , 124 with prior abdominal surgery and 91 with no prior surgery . INTERVENTIONS Surgical histories were review ed , abdominal skin scars noted , and extent of anterior abdominal wall adhesions prospect ively recorded . Statistical analysis was performed with the chi2 test . MEASUREMENTS AND MAIN RESULTS No anterior abdominal wall adhesions were present in 91 patients with no previous surgery  or 45 patients with previous laparoscopy  ( 12 had more than 1 laparoscopy ; p < 0.001 vs laparotomy ) . Seventeen ( 59 % ) of 29 patients with a midline vertical incision had anterior wall adhesions ( p < 0.05 vs suprapubic transverse incision ) . Eleven ( 28 % ) of 39 with a suprapubic transverse incision had anterior wall adhesions ( p < 0.001 vs no surgery or laparoscopy ) . Ninety-six percent of adhesions involved omentum and 29 % included bowel . CONCLUSION Prior laparotomy , whether through a midline vertical or suprapubic transverse incision , significantly increased the frequency of anterior abdominal wall adhesions , and these adhesions may complicate the placement of the laparoscopic cannula through the umbilicus
None of the techniques that were compared significantly reduced the incidence of adhesive small bowel obstruction .
None of the specific techniques that were compared reduced the two main adhesion-related clinical outcomes , small bowel obstruction and infertility .
The meta- analysis provides little evidence for the surgical principle that using less invasive techniques , introducing less foreign bodies or causing less ischaemia reduces the extent and severity of adhesions
INTRODUCTION Adhesion formation is the most common complication following  peritoneal surgery  and the leading cause of small bowel obstruction , acquired infertility and inadvertent organ injury at reoperation .
Using a ' good surgical technique ' is advocated as a first step in preventing adhesions .
However , the evidence for different surgical techniques to reduce adhesion formation needs confirmation .