title: The Effect of Short-Interval Laparoscopic Lysis of Adhesions on Pregnancy Rates Following Nd-YAG Laser Photocoagulation of Polycystic Ovaries Is closure of the peritoneal layer necessary in the repair of midline surgical abdominal wounds? Effects of visceral peritoneal closure on scar formation at cesarean delivery. Evaluation of unilateral versus bilateral ovarian drilling in clomiphene citrate resistant cases of polycystic ovarian syndrome Long-term outcomes of laparoscopic versus open ileocolic resection for Crohn's disease: follow-up of a prospective randomized trial. Long-term outcomes of two different surgical techniques for cesarean. Ovarian endometrioma: postoperative adhesions following bipolar coagulation and suture. Treatment of tubal ectopic pregnancy by salpingotomy with or without tubal suturing and salpingectomy. Non-closure versus closure of peritoneum during cesarean section: a randomized study. Peritoneal closure after lateral paramedian incision Influence of small intestinal serosal defect closure on leakage rate and adhesion formation: a pilot study using rabbit models A Prospective Analysis of Predictive Factors on the Results of Laparoscopic Adhesiolysis in Patients with Chronic Abdominal Pain Choice of incision in surgical management of small bowel perforations in enteric fever. Fertility outcome after conservative surgical treatment of ectopic pregnancy evaluated in a randomized trial. Correlation between the American Fertility Society classifications of adnexal adhesions and distal tubal occlusion, salpingoscopy, and reproductive outcome in tubal surgery. A randomized, controlled pilot study of the safety and efficacy of 4% icodextrin solution in the reduction of adhesions following laparoscopic gynaecological surgery. Electrocautery causes more ischemic peritoneal tissue damage than ultrasonic dissection Pelvic and periaortic pertioneal closure or non-closure at lymphadenectomy in ovarian cancer: effects on morbidity and adhesion formation. Effect of closure versus nonclosure of peritoneum at cesarean section on adhesions: a prospective randomized study. Laparoscopic salpingotomy for tubal pregnancy: comparison of linear salpingotomy with and without suturing. Adhesion formation after microlaparoscopic and laparoscopic ovarian coagulation for polycystic ovary disease. Peritoneal fibrinolytic response to various aspects of laparoscopic surgery: a randomized trial. Chance of adhesion formation after laparoscopic salpingo-ovariolysis: is there a place for second-look laparoscopy? Closure vs non-closure of the visceral and parietal peritoneum at cesarean delivery: 16 year study. Evaluation of ovarian adhesion formation after laparoscopic ovarian drilling by second-look minilaparoscopy. Laparoscopy versus laparotomy for ovarian conservative surgery: a randomized trial in the rabbit model. Salpingo-ovariolysis: a comparison between laser surgery and electrosurgery. Effectiveness of autocrosslinked hyaluronic acid gel after laparoscopic myomectomy in infertile patients: a prospective, randomized, controlled study. Detection of abdominal wall adhesions using visceral slide Peritoneal Closure at Vaginal Hysterectomy: A Reassessment Enterotomy Risk in Abdominal Wall Repair: A Prospective Study Nonclosure of Peritoneum at Radical Abdominal Hysterectomy and Pelvic Node Dissection: A Randomized Study Postoperative adhesion prevention with an oxidized regenerated cellulose adhesion barrier in infertile women. Reduction in Adhesive Small-Bowel Obstruction by Seprafilm® Adhesion Barrier After Intestinal Resection Adhesion formation after laparoscopic surgery in tubal pregnancy: a randomized trial versus laparotomy. Does the peritoneum need to be closed at laparotomy? Closure or non-closure of visceral peritoneums after abdominal hysterectomies and Wertheim-Meigs radical abdominal hysterectomies. Long‐term outcomes following laparoscopically assisted versus open ileocolic resection for Crohn's disease Long-Term Morbidity and Oncologic Outcomes of Laparoscopic-Assisted Anterior Resection for Upper Rectal Cancer: Ten-Year Results of a Prospective, Randomized Trial Anterior abdominal wall adhesions after laparotomy or laparoscopy. Role of microlaparoscopy in the diagnosis of peritoneal and visceral adhesions and in the prevention of bowel injury associated with blind trocar insertion. Reduction of adhesions after uterine myomectomy by Seprafilm membrane (HAL-F): a blinded, prospective, randomized, multicenter clinical study. Seprafilm Adhesion Study Group.
abstract: Laparoscopic Nd-YAG laser photocoagulation of the ovaries was performed in 40 anovulatory women with clomiphene citrate-resistant polycystic ovary disease . Following this procedure , the subjects were r and omly assigned to have either a second-look laparoscopy with lysis of adhesions within 3 - 4 weeks of the initial laparoscopy ( N=19 ) or expectant management ( N=20 ) . One patient assigned to the laparoscopy group refused the procedure . Minimal and mild adhesions that did not distort the normal tubo-ovarian relationship were encountered in 13 patients ( 68 % ) in the second-look laparoscopy group ; these adhesions were easily lysed using sharp or blunt dissection . The pregnancy rates over 6 months were similar in the two groups ( 47 % in the second-look group and 55 % in the expectant-management group ; P>.05 ) . These data suggest that early laparoscopic lysis of adhesions does not improve short-term conception rates following laparoscopic Nd-YAG laser photocoagulation of polycystic ovaries This study describes a prospect i ve r and omized controlled trial to evaluate whether suture of the peritoneal layer is necessary as a separate step in the closure of midline abdominal surgical wounds . Consecutive patients undergoing abdominal operation — elective and emergency surgery — through a midline abdominal wound were r and omized to have the peritoneal layer closed with continuous catgut , or to have this step omitted . The linea alba was closed with interrupted stainless steel sutures , and the skin approximated with staples . Patients were evaluated for wound sepsis , wound dehiscence , and subsequent incisional hernia development . Postoperative pain was assessed by a self-administered visual analogue score , and by measuring narcotic requirements . There was no significant difference in narcotic requirements , pain scores , or wound complications between the 2 groups . Single-layer closure of the abdominal wall is quicker , less costly , and theoretically safer than layered closure , and it is recommended that separate suture of the peritoneum be ab and oned . ResuméDans cette étude prospect i ve , r and omisée , et contrôlée , nous avons cherché à savoir si la fermeture individualisée du péritoine était nécessaire dans la fermeture d'une laparotomie médiane . Deux cents patients consécutifs — opérés à froid ou en urgence — par laparotomie médiane  , ont été r and omisés : dans un groupe , le péritoine a été fermé en un plan individualisé par un surjet au catgut , dans l'autre , le péritoine n'a pas été suturé . La ligne blanche a été fermée en un plan par des points séparés de fils d'acier ; la peau a été fermée par des agrafes . On a étudié le nombre des abcès de paroi , des éviscérations , et , à distance , des éventrations . La douleur postopératoire a été évaluée par un score analogue visuel , établi par le patient lui-même , ainsi que par la nécessité d'utiliser des antalgiques . Il n'y avait pas de différence significative entre les 2 groupes en ce qui concerne le taux de complications pariétales ou l'existence de douleur . Comme la fermeture pariétale en un seul plan est plus rapide , coûte moins cher , et , est théoriquement plus sûre ( on peut surveiller le contenu intrapéritonéal pendant la fermeture ) que la fermeture plan par plan , nous recomm and ons d'ab and oner la fermeture individualisée du péritoine . ResumenEl presente articulo describe un ensayo clínico prospect ivo destinado a investigar si es necesaria la sutura de la capa peritoneal como un paso independiente en el cierre de incisiones abdominales de línea media . Una serie de pacientes consecutivos sometidos a operaciones abdominales fueron r and omizados a cierre peritoneal con sutura continua de catgut  o a omisión de este paso . La línea alba fue cerrada con suturas interrumpidas de acero inoxidable y la piel con agrafes . Se estudió la incidencia de infección de herida , de dehiscencia , y de desarrollo de hernia incisional subsiguientes . La valoración del dolor postoperatorio fue realizada mediante autoevaluación con una escala linear análoga y la determinación de los requerimientos de narcóticos . No se encontraron diferencias significativas en el requerimiento de narcóticos para analgesia , en el nivel de la escala de dolor , o en la tasa de complicaciones entre los 2 grupos . El cierre de la pared abdominal en una capa única es más rápido , menos costoso , y teóricamente más seguro ; por lo tanto , se recomienda ab and onar la sutura del peritoneo OBJECTIVE To determine the effect of closure or non-closure of the visceral peritoneum at cesarean delivery on uterine scar formation assessed at repeat cesarean delivery . METHODS Women undergoing initial cesarean delivery were allocated into 2 groups : group 1 underwent visceral peritoneal closure , while in group 2 the visceral peritoneum was not closed . At repeat cesarean delivery 4 specimens from the initial uterine scar were collected and assessed by light microscopy and scanning electron microscopy . RESULTS In group 1 , 57 % of women had adhesions compared with 20.6 % in group 2 ( P<0.05 ) . Light microscopy revealed reactive mesothelial hyperplasia ( 51.8 % vs 13.7 % ) , submesothelial fibrosis ( 48.1 % vs 6.8 % ) , and neoangiogenesis of mesothelial stroma ( 44.4 % vs 12 % ) in group 1 and group 2 patients , respectively ( P<0.05 ) . Scanning electron microscopy showed more patients with pericytes on the surface of microvessels in group 1 compared with group 2 ( 26.3+/-1.4 vs 11.5+/-1.1 patients ; P<0.05 ) . CONCLUSION Closure of the visceral peritoneum at cesarean delivery may produce an inflammatory reaction and adhesions , evidence d by reactive and regenerative mesothelial hyperplasia and submesothelial fibrosis Objectives Laparoscopic ovarian drilling ( LOD ) has been put forward as the treatment of choice in women with clomiphene citrate (CC)-resistant polycystic ovary syndrome ( PCOS ) , with tubo-ovarian adhesion formation as the major disadvantage . Our study proposed to compare the efficacy of laparoscopic unilateral ovarian drilling with bilateral ovarian drilling in terms of ovulation and pregnancy rate with the expected advantage of decreasing postoperative adhesion rate and change in fimbiro ovarian relationship with unilateral drilling . Methods This prospect i ve r and omized study included 44 patients with anovulatory infertility due to PCOS . Twenty-two patients underwent unilateral ovarian drilling  in group-I and 22 patients underwent bilateral ovarian drilling in group-II between June 2005 and June 2007 . The number of drilling site in each ovary was limited to five . The clinical and biochemical response , ovulation and pregnancy rates over a follow-up period of 1 year were compared . Tubo-ovarian adhesion rate was compared during cesarean section or during repeat laparoscopy . Results There was no statistical difference between the two groups in terms of clinical and biochemical response , ovulation rate and pregnancy rate . Postoperatively , tubo-ovarian adhesions could be assessed in 36.3 % of the patients and no adhesions were found in a single case in either group . Conclusion Unilateral drilling cauterization of ovary is equally efficacious as bilateral drilling in inducing ovulation and achieving pregnancy .  Unilateral ovarian drilling may be a suitable option in clomiphene citrate resistant infertility patient of PCOS which can replace bilateral ovarian drilling with the potential advantage of decreasing the chances of adhesion formation BACKGROUND The purpose of this study was to analyze long-term recurrence rates and complications in patients previously enrolled in a prospect i ve r and omized trial comparing laparoscopic ( LC ) and open ileocolectomy ( OC ) for ileocolic Crohn 's disease ( CD ) . METHODS Follow-up data were available on 56 of 60 patients .  Demographic data , recurrence rates , need for additional surgery related to primary procedure , and medication use were recorded . RESULTS Mean follow-up for 56 patients ( 27 LC vs 29 OC ) was 10.5 years and comparable between LC and OC ( 10.0 vs 11.0 , respectively ; P = .64 ) . One patient died 8 years after OC of causes unrelated to CD . Eight patients for each group underwent initial reoperative ( 26 % LC vs 28 % OC ; P = .89 ) . One patient underwent incisional hernia repair  after LC ( 4 % ) versus 4 patients ( 14 % ) after OC ( P = .61 ) . Two patients in the LC group underwent  adhesiolysis  versus none after OC ( P = .23 ) . Incidences of anorectal disease , anorectal surgery , endoscopic or radiologic recurrence , and medication use were also similar between LC and OC . OC patients requiring operation during follow-up were significantly more likely than LC to require multiple operations ( P = .006 ) . CONCLUSIONS Long-term data from this prospect i ve r and omized trial confirm that LC is at least comparable to OC in the treatment of ileocolic CD OBJECTIVE To assess the rate of adhesions and other long-term outcomes of two cesarean delivery techniques . METHODS A total of 600 women were r and omly assigned to either a st and ard ( Pfannenstiel-Kerr ) or modified ( Joel-Cohen-Stark ) technique for first-time cesarean delivery . A total of 124 women were assessed at repeat cesarean delivery . The primary outcome measure was the presence of adhesions . RESULTS At repeat cesarean delivery , anesthesia-to-delivery time , total duration of surgery , change in hemoglobin level , time to mobilization and oral intake , and postoperative hospital stay were significantly less with the modified technique . Adhesions were found in 7 ( 11.3 % ) and 22 ( 35.5 % ) of the cases using the modified and st and ard techniques , respectively ( P=0.0026 ; relative risk 3.14 [ 95 % CI , 1.45 - 6.82 ] ) . CONCLUSION A modified cesarean delivery technique , including Joel-Cohen incision , exteriorized full thickness suturing of the uterine incision , and non-closure of the peritoneum may reduce long-term morbidities of the procedure OBJECTIVE To compare bipolar coagulation and suturing of the ovary in terms of postoperative ovarian adhesions after  laparoscopic ovarian cystectomy for endometriosis . DESIGN Prospect i ve , r and omized , controlled study . SETTING Department of Obstetrics and Gynecology , University of Naples " Federico II . " PATIENT(S ) Thirty-two women with a single endometriotic cyst were r and omly divided into two groups of 16 women each ( groups A and B ) . INTERVENTION(S ) All patients underwent laparoscopic ovarian cystectomy for endometriosis . In group A , hemostasis was performed by closure of the ovary with an intraovarian suture . In group B , complete hemostasis was achieved only with bipolar coagulation on the internal face of the ovary . MAIN OUTCOME MEASURE(S ) Rate and extension of postsurgical ovarian adhesions at 60 - 90 days follow-up . RESULT ( S ) At follow-up , a significantly lower rate of postsurgical ovarian adhesions was observed in group A than in group B ( 30.8 % vs. 57.1 % ) . The extension of ovarian adhesions was significantly higher in group B than in group A. CONCLUSION ( S ) The use of sutures on ovaries treated for endometrioma is associated with a lower rate of postoperative ovarian adhesion formation compared with bipolar coagulation Thirty-four women with unruptured tubal ectopic pregnancy ( EP ) were r and omly assigned to undergo salpingotomy without tubal suturing ( n = 15 ) or salpingotomy with tubal suturing ( n = 19 ) . The reproductive performance of these patients was compared with 24 patients who underwent salpingectomy for their EP ( historical control ) . Using life table analysis , the cumulative probability of intrauterine pregnancy ( IUP ) at 12 and 24 months was 45 % and 45 % after salpingotomy without tubal suturing and 21 % and 47 % after salpingotomy with tubal suturing , respectively . The cumulative probability of IUP after salpingectomy ( 21 % and 26 % at 12 and 24 months , respectively ) was significantly lower than after salpingotomy with or without tubal suturing . There was no difference in the cumulative probability of EP after salpingotomy with or without tubal suturing , but it was significantly higher than after salpingectomy . In 18 women who subsequently underwent laparoscopy or laparotomy  , no significant difference was found between the degree of adhesions after salpingotomy with or without tubal suturing . These findings suggest that IUP after conservative treatment is higher than after salpingectomy , but recurrent EP is also higher . Intrauterine pregnancy occurs earlier after salpingotomy without tubal suturing than after salpingotomy with tubal suturing . This might be because of rapid return of tubal function after healing by secondary intention 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 The lateral paramedian incision has been advocated as the strongest incision for abdominal surgery . We have evaluated this incision and tested the necessity for closing the deep peritoneal layer by a prospect i ve r and omized trial . All 206 patients undergoing laparotomy in the Surgical Unit in 1984 , both elective and emergency cases , were included . In patients undergoing laparotomy through unscarred tissue , a lateral paramedian incision was performed and they were r and omized to have either the peritoneum closed ( n = 77 ) or left open ( n = 75 ) . Patients in whom the laparotomy was performed through a previous incision ( n = 51 ) and those in whom the abdomen had to be opened urgently ( n =3 ) were excluded from the trial but studied separately ( n = 54 ) . The rectus sheath was closed with monofilament nylon in all cases . Patients were assessed for wound integrity during the immediate postoperative period and at 1 , 3 , 6 and 12 months after operation . So far the patients have been followed up for between 1 and 2 years and follow‐up is continuing as in some cases incisional hernia may not be detected until several years after operation . There have been no cases of burst abdomen . No incisional hernias have developed in patients in whom a lateral paramedian incision was performed and the peritoneum was closed , and one incisional hernia has occurred in the patients in whom the peritoneum was left open . Seven incisional hernias have occurred in patients excluded from the trial of the lateral paramedian incision ( 13 per cent ) . We conclude that the lateral paramedian incision successfully abolishes the burst abdomen and that incisional hernia is rare . It is not necessary to close the peritoneum with this incision 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 Laparoscopic adhesiolysis for chronic abdominal pain  is subject for criticism . In this prospect i ve study , we analyze factors that encourage or discourage the indication for therapeutic laparoscopic adhesiolysis .  Two hundred twenty-four consecutive patients with chronic abdominal pain underwent diagnostic laparoscopy , and in case of adhesions , they underwent adhesiolysis .  Pain relief was assessed , and the individual impact of variables on pain relief was determined . Laparoscopy was performed in 224 patients . Two hundred patients had only adhesions and underwent primary laparoscopic adhesiolysis .  Three months after adhesiolysis , 74 % of patients were pain-free or had less pain . The remaining 26 % of the patients felt no change ( 22 % ) or had more pain ( 4 % ) . Gender , age , and bowel perforation leading to a laparotomy appear to be individual factors significantly influencing pain relief .  Laparoscopic adhesiolysis can be done ( almost ) completely in 92 % of patients with adhesions . After laparoscopic adhesiolysis , 74 % of patients had good results and 4 % had more pain . The complication rate is high Fifty six patients with typhoid enteric perforation who underwent operative treatment were r and omly assigned to 2 groups . Twenty seven patients in group A underwent laparotomy via the Rutherford-Morrison incision while 29 patients in group B underwent the same procedure via a right paramedian incision . Surgical treatment consisted of two layer closure of the perforation with peritoneal lavage and tube drainage in all cases . Mean operating time in group A and group B was 45 + /- 10 minutes and 73 + /- 6 minutes respectively ( p < 0.001 ) . Postoperative wound dehiscence in group A and group B was observed in 2 and 11 cases respectively ( p < 0.001 ) . Incisional hernia developed in 8 patients in group B and none in group A ( p < 0.01 ) . Two patients in group A and 10 in group B developed adhesion-obstruction ( p < 0.05 ) . Differences in wound sepsis , pelvic abscess and mortality were not significant . Mean hospital stay in groups A and B was 12.4 days and 16.8 days respectively ( p < 0.001 ) . We conclude that in the presence of a confirmed preoperative diagnosis of typhoid enteric perforation , laparotomy via the Rutherford-Morrison incision may significantly reduce postoperative wound complications and morbidity without significantly altering the overall outcome OBJECTIVE To evaluate the fertility outcome after laparoscopic surgery for ectopic pregnancy . DESIGN A r and omized trial versus laparotomy was performed between May 1987 and June 1989 . SETTING The study was conducted in a clinical university center , the Sahlgrens Hospital . PATIENTS A group of 105 patients with tubal pregnancy were stratified with regard to risk determinants and age and r and omized to laparoscopy or laparotomy .  Eighty-seven patients who desired pregnancy were evaluated for subsequent fertility outcome . INTERVENTIONS Linear salpingotomy was performed in both surgical groups . MAIN OUTCOME MEASURE We evaluated the fertility outcome after laparoscopic salpingotomy for comparison with the outcome after laparotomy . RESULTS There was no difference between the groups in the overall fertility outcome . A substantially higher proportion of patients in the laparotomy group were subjected to adhesiolysis performed at a second-look laparoscopy . CONCLUSIONS The fertility prospect s are not impaired by laparoscopic surgery . Adhesiolysis at a second-look laparoscopy , especially after laparotomy , might be beneficial in selected cases and may serve to improve subsequent fertility OBJECTIVE To compare the prognostic value of salpingoscopy with a current classification system of adnexal adhesions and distal tubal occlusion in patients with tubal infertility undergoing reconstructive tubal surgery .  DESIGN Prospect i ve clinical study . SETTING Department of Obstetrics and Gynecology of the Catholic University , a tertiary care University Center in Rome , Italy . PATIENTS Fifty-five infertile patients with either adnexal adhesions ( 29 patients ) or hydrosalpinx ( 26 patients ) undergoing reconstructive tubal surgery .  INTERVENTIONS Salpingoscopy performed concomitantly to salpingo-ovariolysis or salpingoneostomy at the time of either operative laparoscopy or laparotomy using microsurgical techniques . MAIN OUTCOME MEASURES Salpingoscopic findings were compared with a current classification system of adnexal adhesions and distal tubal occlusion . The patients were followed for a mean follow-up of 49 months ; the pregnancy rates achieved were correlated with the salpingoscopic findings and the classification system used . RESULTS There was a significant correlation between the salpingoscopic grade and the occurrence of a term pregnancy for both the salpingo-ovariolysis and salpingoneostomy groups of patients . There was no significant correlation between the classification system used and the occurrence of a term pregnancy for both groups of patients . CONCLUSION Salpingoscopy plays an important role in selecting the patients who may benefit the most from reconstructive tubal surgery BACKGROUND Adhesion-related readmissions are frequent sequelae to gynaecological surgery . Attempts to prevent adhesions by separating healing peritoneal surfaces include site-specific barriers and hydroflotation by instilled solutions . Rapid absorption limits the effectiveness of solutions such as Ringer 's lactated saline ( RLS ) . This pilot study assessed the safety , tolerability and preliminary effectiveness of a non-viscous , iso-osmolar solution of 4 % icodextrin , an alpha-1,4 glucose polymer with prolonged intraperitoneal residence , in reducing adhesions after laparoscopic gynaecological surgery . METHODS Women aged > or = 18 years , requiring laparoscopic adnexal surgery ( n = 62 ) , were entered into a r and omized , open-label , assessor-blinded , multicentre study to compare 4 % icodextrin with RLS . Treatments were coded in blocks of four with equal r and omization to each group , and pre-allocated to consecutively numbered patients . At least 100 ml per 30 min was used for intra-operative lavage , with 1 l instilled post-operatively . Per protocol analysis included all eligible patients ( n = 53 ) ; reformation analysis required one or more baseline adhesion ( n = 42 ) . Incidence , extent and severity of post-operative adhesions were assessed at second-look laparoscopy after 6 - 12 weeks . Procedures were video-taped for third party , blinded assessment . RESULTS Safety and tolerability ( laboratory variables , adverse events , clinical follow-up ) were good with no difference between treatments . A shift analysis of incidence-ranked adhesions ( n = 53 ) showed apparent improvements in more patients with icodextrin than RLS ( 37 versus 15 % ; not significant ) . Adhesion score reduction ( n = 42 ) was more frequent in icodextrin- than RLS-treated patients : incidence ( 52 versus 32 % ) , extent ( 52 versus 47 % ) , and severity ( 65 versus 37 % ) . Despite greater baseline adhesions , median reformation was less after icodextrin ( 24 % ) than RLS ( 60 % ) . The pilot study group sizes were not powered for statistical significance . CONCLUSIONS In this preliminary study , 4 % icodextrin lavage plus instillation was well tolerated and reduced adhesion formation and reformation following laparoscopic gynaecological surgery . A Phase III pivotal study is currently in progress Background Minimizing peritoneal tissue injury during abdominal surgery has the benefit of reducing postoperative inflammatory response , pain , and adhesion formation .  Ultrasonic dissection seems to reduce tissue damage . This study aim ed to compare electrocautery and ultrasonic dissection in terms of peritoneal tissue ischemia measured by microdialysis . Methods In this study , 18 Wistar rats underwent a median laparotomy and had a peritoneal microdialysis catheter implanted in the left lateral sidewall . The animals were r and omly assigned to receive two st and ard peritoneal incisions parallel to the catheter by either ultrasonic dissection or electrocautery . After the operation , sample s of microdialysis dialysate were taken every 2 h until 72 h postoperatively for measurements of pyruvate , lactate , glucose , and glycerol , and ratios were calculated . Results The mean lactate – pyruvate ratio ( LPR ) , lactate – glucose ratio ( LGR ) , and glycerol concentration were significantly higher in the electrocautery group than in the ultrasonic dissection group until respectively 34 , 48 , and 48 h after surgery . The mean areas under the curve ( AUC ) of LPR , LGR , and glycerol concentration also were higher in the electrocautery group than in the ultrasonic dissection group ( 4,387 vs. 1,639 , P = 0.011 ; 59 vs. 21 , P = 0.008 ; 7,438 vs. 4,169 , P = 0.008 , respectively ) . Conclusion Electrosurgery causes more ischemic peritoneal tissue damage than ultrasonic dissection The effects of pelvic and periaortic peritoneal closure or ( non-closure ) on morbidity and adhesion formation were prospect ively compared in 102 patients with ovarian cancer who had undergone a pelvic and periaortic lymphadenectomy .  Hysterectomy with bilateral salpingoophorectomy , bilateral pelvic and periaortic lymphadenectomy , omentectomy , appendectomy and lysis of pelvic adhesions for the st and ardization of initial adhesion scores was performed on all patients . The pelvic and periaortic peritoneum were re-approximated in group I ( n = 50 ) patients , and left open in group II ( n = 52 ) patients . The groups were similar for mean age , previous surgery , tumour histology and disease stage . Morbidity characteristics such as blood loss , transfusion rate , post-operative infectious and non-infectious complications , and total hospital stay were also similar . After six courses of PAC ( cisplatin 50 mg/m(2 ) , Adriamycin 50 mg/m(2 ) , cyclophosphamide 500 Mg/M(2 ) ) chemotherapy , all patients underwent a second-look laparotomy . Persistent cancer was detected in 49 of 102 ( 48.03 % ) patients . Adhesion scores were detected at the time of second-look laparotomy . Adhesion scores for group I ( 8.9 + /- 2.9 ) were significantly higher than the group II ( peritoneum non-closure ) ( 5.8 + /- 2.3 ) ( P<0.01 ) . Closing the pelvic and periaortic peritoneum did not effect morbidity , but leaving the pelvic and periaortic peritoneum open significantly decreased the adhesion formation OBJECTIVE We sought to determine the effect of nonclosure of the visceral and parietal peritoneum during cesarean section on the formation of adhesions . STUDY DESIGN This was a prospect i ve r and omized trial of 533 women undergoing primary cesarean section ; in 256 the peritoneum was left open and in 277 it was closed . Fifty women in the nonclosure group and 47 women in the closure group were subsequently evaluated intraoperatively at a repeat cesarean . The presence of adhesions and their severity were evaluated at several sites . RESULTS The nonclosure and closure groups were comparable with regard to the proportion of patients with adhesions at any site ( 60 % vs 51 % , respectively ; P = .31 ) . Time from incision to delivery was comparable in the nonclosure and closure groups ( 8.98 ± 4.7 vs 9.32 ± 5.2 minutes , respectively ; P = .84 ) . CONCLUSION Closure or nonclosure of the peritoneum at cesarean section did not lead to large differences in the adhesion rate BACKGROUND The study was carried out to clarify the incidence of post-operative tubal adhesions , patency rate and pregnancy outcome after laparoscopic salpingotomy with and without suturing for tubal pregnancy . METHODS From May 1996 to December 2002 , a total of 97 cases of tubal pregnancy were treated in our centre by laparoscopic conservative surgery . The successful salpingotomy cases were r and omly assigned to undergo salpingotomy without suturing ( group I ; n = 43 ) or with suturing ( group II ; n = 32 ) . We compared these patients and assessed their surgical and pregnancy outcome by second look laparoscopy ( SLL ) 3 months after the first operation . RESULTS Seventy-five cases ( 77 % ) were treated successfully by salpingotomy at initial laparoscopic surgery , and the remaining 22 cases were unsuccessful because of bleeding or complete tubal damage . Pelvic findings were assessed at SLL in 21 of 43 cases ( 49 % ) in group I and 17 of 32 ( 53 % ) in group II . There were no significant differences in gestational age , ectopic site , tubal diameter , tubal condition , intraperitoneal haemorrhage and pre-operative HCG levels between the two groups . Only the operation time was longer in group II than in group I ( 91 + /- 15 versus 69 + /- 15 min , P < 0.05 ) . The tubal patency rate of the treated side was 90 % ( 19/21 ) in group I and 94 % ( 16/17 ) in group II . Also the peritubal adhesions were observed in 33 % ( 7/21 ) in group I and 29 % ( 5/17 ) in group II , and were mostly comprised of filmy adhesions . A tubal fistula occurred in two cases in each group . Pregnancy rate was 79 % ( 15/19 ) in group I and 92 % ( 12/13 ) in group II , and this did not reveal any significant difference of cumulative pregnancy rate between the groups . CONCLUSION We recommend laparoscopic linear salpingotomy as a useful method in the management of cases with tubal pregnancy who desire future pregnancy . This preliminary study emphasizes that the procedure involving suturing has no additional benefit over the non-suturing technique during salpingotomy 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 BACKGROUND Peritoneal fibrinolysis is important in peritoneal wound healing processes and adhesion formation . The peritoneal fibrinolytic response to laparoscopy is merely unknown . In the present study we investigate the effect of short-term laparoscopy on the peritoneal fibrinolytic response and the influence of intra-abdominal pressure , light intensity and choice of dissection device on this response . METHODS There were 50 patients scheduled for laparoscopic cholecystectomy r and omized in five groups operated with various pressures , light intensities , and dissection devices .  Peritoneal biopsies were taken at the beginning and the end of the procedure . Tissue concentrations of tissue-type plasminogen activator ( tPA ) , urokinase-type plasminogen activator ( uPA ) , plasminogen activator inhibitor type 1 ( PAI-1 ) , and the tPA-activity were measured using ELISA techniques . RESULTS There were no differences in tPA antigen , tPA-activity , uPA antigen , or PAI-1 antigen concentrations in biopsies taken at the beginning compared to sample s taken at the end of the operation . Different intra-abdominal pressures , light intensities and the choice dissection device did not affect any of the measured parameters . CONCLUSION Short-term laparoscopy does not affect the peritoneal fibrinolytic activity . The used intra-abdominal pressure , light intensity and choice of dissection device do not affect peritoneal activity during short-term laparoscopy 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 OBJECTIVE To determine whether non-closure of visceral and parietal peritoneum at LSCS has advantages over peritoneal closure with regard to postoperative complication and adhesions . STUDY DESIGN Prospect i ve r and omized controlled trial . SETTING Paholpolpayuhasena Hospital , Kanchanaburi province , Thail and SUBJECTS AND METHOD Three hundred and sixty full-term pregnant women undergoing first cesarean section were divided into 3 groups ( N = 120 ) . Group A : non-closure of both visceral and parietal peritoneum . Group B. non-closure of only visceral peritoneum . Group C : closure of both visceral and parietal peritoneum .  Postoperative complications were compared . Adhesions were evaluated in 65 patients returning for a second LSCS and compared for severity of adhesions . The three groups were compared using statistical analysis . RESULT There was no significant statistical difference between group A and C , group B and C for postoperative complications or number of adhesion formation . However , adhesions in the closure group were more severe . CONCLUSIONS Closure of visceral and parietal peritoneum has no benefit over non-closure of visceral peritoneum and non-closure of both visceral and parietal peritoneum at LSCS OBJECTIVE To determine the incidence , site , and grade of ovarian adhesion formation after  laparoscopic ovarian drilling ( LOD )  and analyze the association between the number of punctures made and the incidence and grade of adhesions , and evaluate the lateral distribution of the adhesions . DESIGN Prospect i ve clinical study . SETTING University hospital endocrine and infertility center . PATIENT(S ) Ninety-six anovulatory infertile women with polycystic ovarian syndrome ( PCOS ) treated with LOD .  INTERVENTION(S ) Women were r and omized into two study groups of 48 women each , one treated with 6 punctures on the left ovary and 12 on the right , and the other treated with 6 punctures on the right ovary and 12 on the left . A short-term second-look minilaparoscopy was performed to evaluate postsurgical adhesion formation . MAIN OUTCOME MEASURE(S ) [ 1 ] Evaluation of the incidence and grade ( thin , dense , cohesive ) of ovarian adhesions ; [ 2 ] comparative analysis of the incidence and grade of ovarian adhesions between ovaries treated with 6 and 12 punctures ; and [ 3 ] comparative analysis of the incidence and grade of ovarian adhesions between the two sides . RESULT ( S ) Adhesion formation was detected in 54 of the 90 women ( 60 % ) and in 83 of the 180 ovaries treated ( 46 % ) . Dense adhesions were more likely to develop on the left ovaries to a statistically significant extent , and independently of the number of ovarian punctures performed ( odds ratio [ OR ] = 4.34 , 95 % confidence interval [ CI ] = 1.72 - 10.94 ) . Logistic regression analysis showed that the incidence of ovarian adhesions was independent of both number of punctures ( OR = 1.05 , 95 % CI = 0.58 - 1.88 ) and side ( OR = 1.37 , 95 % CI = 0.76 - 2.46 ) . CONCLUSION ( S ) The incidence of ovarian adhesion formation after LOD was high , and their extent and severity was not influenced by the number of ovarian punctures ; however , the left ovary appeared more prone to develop severe adhesions than the contralateral one OBJECTIVE Our purpose was to compare postoperative adhesion formation and reproductive outcome after the same ovarian surgical procedure performed by laparoscopy or laparotomy by means of microsurgical techniques . STUDY DESIGN Twenty-eight New Zeal and White female rabbits were r and omly assigned to laparotomy or laparoscopy for the same st and ardized surgical procedure : both ovaries were grasped with atraumatic forceps and longitudinally incised on the antimesenteric side from the cortex to the hilum with a microelectrode delivering a tissue power density of 66,666 W/cm . The rabbits were then mated , and 2 weeks later a second-look laparotomy was performed by a blinded observer for the evaluation of postoperative adhesions , number of corpora lutea in each ovary , number of embryos in the ipsilateral uterine horn , and nidation index for each side . RESULTS At second look no statistically significant differences were found in postoperative adhesion formation , number of corpora lutea , number of embryos , and nidation index between the laparoscopy and the laparotomy groups . CONCLUSION Laparoscopy or laparotomy for ovarian conservative surgery do not appear significantly different in postoperative adhesion formation and reproductive outcome in the rabbit model A prospect i ve , r and omized study comparing the result of salpingo-ovariolysis using the carbon dioxide ( CO2 ) laser and the microdiathermy needle was conducted . The pregnancy rate after laser surgery was 53.3 % ( n = 30 ) and after electrosurgery was 51.5 % ( n = 33 ) at 2-year follow-up . Although the surgery-conception interval after laser surgery ( 9.9 + /- 2.0 months ) tended to be shorter than after electrosurgery ( 13.1 + /- 2.0 months ) , no statistical difference was reached . This report suggests that there is no difference between the pregnancy rate after salpingo-ovariolysis with the use of the CO2 laser or with the use of the microdiathermy needle . The surgery-conception interval , however , tends to be shorter after laser surgery . A larger series of patients is required to clarify the latter OBJECTIVE To assess the efficacy of autocrosslinked hyaluronic gel in postsurgical adhesion prevention after laparoscopic myomectomy . DESIGN Prospect i ve , r and omized , controlled study . SETTING University of Naples " Federico II".Thirty-six infertile women with symptomatic myomas were r and omly divided into two groups of 18 patients each . INTERVENTION(S ) Laparoscopic myomectomy with subserous sutures or interrupted figure 8 sutures , with ( group A ) or without ( group B ) application of autocrosslinked hyaluronic acid ( HA ) gel . MAIN OUTCOME MEASURE(S ) Rate of postsurgical adhesions at 60 - 90 days of follow-up . The rate of subjects who developed postoperative adhesions was significantly lower in group A in comparison with group B ( 27.8 % vs. 77.8 % ) . In both groups , the rate of adhesions was significantly higher in patients treated with interrupted figure 8 sutures than with subserous sutures . CONCLUSION ( S ) Autocrosslinked HA gel is a promising resorbable agent barrier for the reduction of postoperative adhesions after laparoscopic myomectomy . Moreover , the type of suture is a factor influencing the postsurgical adhesion formation 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 Objective To evaluate the clinical outcome of patients who underwent vaginal hysterectomy with or without peritoneal closure .  Methods This study was a r and omized trial . Using computer-generated numbers , all patients undergoing vaginal hysterectomy without oophorectomy  were r and omized to either no peritoneal closure ( n = 57 ) or routine peritoneal closure ( n = 49 ) . Patients were followed-up for a minimum of 1 year for development of complications and postoperative dyspareunia . At 4–6 postoperative weeks , the distance between the ovaries and the vaginal cuff was measured by  ultrasound .  Results Postoperative complications were similar in both groups . The incidence of deep-thrust dyspareunia at 6 and 12 months was also similar . No statistical differences between the two groups were noted in the ovary to vaginal cuff distances either overall or when patients with dyspareunia were considered separately . Conclusion The data in this study do not support the use of reperitonealization on a routine basis . However , because of a lack of statistical power , larger studies will be required to confirm this theory Objectives : To establish the incidence and predictive factors of enterotomy made during adhesiolysis in abdominal wall repair and to assess the impact of enterotomies and long-lasting adhesiolysis on postoperative morbidity such as sepsis , wound infection , abdominal complications and pneumonia , and socioeconomic costs . Background : Adhesions frequently complicate surgical repair of abdominal wall hernia . Enterotomies made during adhesiolysis specifically have a large impact on morbidity of patients , especially surgical site infections . Little is known on the incidence and burden of enterotomies and long-lasting adhesiolysis in abdominal wall repair . Methods : Between June 2008 and June 2010 demographics , disease characteristics and perioperative data of all patients undergoing elective abdominal wall repair were included in a prospect i ve cohort study that was focused on adhesiolysis-related problems . A trained research er observed all surgeries and collected data on adhesion location , tenacity , adhesiolysis time , and inadvertent organ damage such as enterotomies . Primary outcome was the incidence of enterotomy , and predictive factors for enterotomy were assessed through univariate and multivariate analyses . In addition , we evaluated the impact of adhesiolysis and enterotomy on morbidity . Results : A cohort of 133 abdominal wall repairs was analyzed .  Adhesiolysis  was required in 124 ( 93.2 % ) , with a mean adhesiolysis time of 35.7 ± 29.8 minutes . Thirty-three enterotomies were made in 17 patients ( 12.8 % ) . Two patients had a delayed diagnosed bowel perforation . Adhesiolysis time , hernia size greater than 10 cm , and fistula were significant predictive factors in univariate analysis . In multivariate analysis , only adhesiolysis time was a significant and independent predictive factor for enterotomy ( P = 0.004 ) . Trends toward an increased risk were seen for patients with mesh in situ and hernia size greater than 10 cm . Patients with enterotomy had significantly more urgent reoperations ( P = 0.029 ) , and they more often required parenteral feeding ( P = 0.037 ) . Moreover , patients with extensive adhesiolysis ( adhesiolysis time , > 30 minutes ) more often suffered from wound infection ( 9/63 vs 2/70 ; P = 0.025 ) , abdominal complications ( 5/63 vs 0/70 ; P = 0.022 ) , and sepsis ( 4/63 vs 0/70 ; P = 0.048 ) . Conclusions : One in 8 patients undergoing abdominal wall repair suffer inadvertent enterotomy following adhesiolysis . Adhesiolysis time predicts enterotomy . Morbidity in patients with extensive adhesiolysis and adhesiolysis complicated by enterotomy is high , inducing longer hospital stay and increased health care utilization Objective To compare closure and nonclosure of the peritoneum at radical abdominal hysterectonmy and pelvic node dissection with respect to postoperative morbidity . Methods Women with uterine cancer who underwent radical abdominal hysterectomy and node dissection type II or III of Piver-Rutledge were assigned r and omly to have a st and ard closure of pelvic and parietal peritoneum and placement of a T-shaped suction drain or to have the peritoneum left open but the vagina closed and two abdominal drains placed . Adjuvant radiotherapy was given to patients with risk factors . The postoperative incidence of lymphocysts ( within 8 weeks from the operation and after 1 year ) and infection-related and non-infection-related complications were analyzed . Results One hundred twenty subjects were enrolled , of whom 59 had peritoneal closure and 61 did not . Both groups were similar with regard to age , weight , nodes removed , nodal metastases , operative time , type of surgery , need for transfusion , and incidence of postoperative radiotherapy . The median follow-up was 36 months ( range 11–72 ) . Eleven patients died , four because of treatment-related complication . The amount of drainage was significantly higher in the closed group than in the unclosed group ( median 740 mL , range 50–5980 versus median 340 mL , range 40–4000 ; P < .005 ) . The incidence of asymptomatic lymphocysts was similar in the closed and open groups at 2 weeks ( 17 of 59 versus 15 of 6 , respectively ) , at 8 weeks ( eight of 56 versus ten of 61 , respectively ) , and after 1 year ( one of 21 versus four of 22 , respectively ) . No difference was found between closed and open groups in terms of symptomatic lymphocysts ( one of 59 versus two of 61 , respectively ) , wound and pelvic infection ( seven of 59 versus 11 of 61 , respectively ) , febrile morbidity ( two of 59 versus one of 61 , respectively ) , and obstruction ( zero of 59 versus one of 61 , respectively ) . Conclusion Nonclosure of the peritoneum at radical abdominal hysterectomy and node dissection is not hazardous and is not associated with an increased incidence of infection- or adhesion-related complications OBJECTIVE To evaluate the efficacy of an oxidized regenerated cellulose adhesion barrier as an adjuvant in preventing postoperative adhesions in infertile women undergoing reconstructive surgery . STUDY DESIGN Thirty-eight cases of reconstructive surgery that could be followed up for more than two years ( myomectomy 19 , cystectomy 5 , tuboplasty 10 , uteroplasty 4 ) at the Fujita Health University Hospital were evaluated retrospectively . The barrier ( Intercede , Johnson & Johnson ) was used to cover the surgical site in 23 of these cases ( Intercede group ) ; no adjuvant was used in 15 cases , which represent the surgical control group ( Intercede - group ) , including 23 second-look operation cases ( 16 in the Intercede and 7 in the control group ) . Postoperative adhesion prevention and pregnancy rates were estimated . RESULTS At the second-look operation , six cases ( 37.5 % ) in the Intercede + group and six ( 85.7 % ) in the Intercede - group had postoperative adhesions . No significant difference was found in either intensity or area covered with adhesions between the two groups . Eighteen cases ( 78.3 % ) in the Intercede and seven ( 46.7 % ) in the Intercede - group conceived during the follow-up period . CONCLUSION The use of Intercede significantly reduced the rate of postoperative adhesion formation , with a statistically significant increase in the pregnancy rate as compared to the surgical controls 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 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 Closure of vertical laparotomy wounds was r and omized between a two‐layer technique of continuous catgut to peritoneum and continuous nylon to sheath and a one‐layer technique in which the peritoneal suture line was omitted . In 162 two‐layer closures there were 4 burst abdomens and 7 wound hernias ( 6·8 per cent wound failures ) ; in 164 one‐layer closures there were 5 burst abdomens and 7 hernias ( 7·3 per cent failures ) . Of 21 patients in this series with jaundice  , the abdominal wounds dehisced in 3 , and 4 patients developed incisional hernias ( 33·3 per cent failures ) compared with a 5·2 per cent failure rate in the 305 non‐jaundiced patients ( P < 0·01 ) The effect of visceral peritoneal closure after  conventional abdominal hysterectomies and Wertheim-Meigs radical operations  was studied clinical ly . No considerable differences were found in the postoperative staying period ; however , the incidence of complications were less in the  peritoneal non-closure group ( n = 91 ) than in the control , peritonealized group ( n = 149 ) . Significantly lower was the number of postoperative irregular pyelogram in cases without peritoneal closure ( n = 25 ) of radical abdominal operations than in the control group ( n = 49 ) with peritoneal suturing . We therefore suggest that the lack of suturing of visceral peritoneums has some advantages after  abdominal hysterectomies  and especially has benefits for Wertheim-Meigs operations Long‐term results of laparoscopically assisted versus open ileocolic resection  for Crohn 's disease were evaluated in a r and omized trial PURPOSE : We have previously reported the five-year results of a r and omized trial comparing laparoscopic and open resection for cancer of the upper rectum and rectosigmoid junction . The aim of this follow-up study is to report on the long-term morbidity and ten-year oncologic outcomes among the subgroup of patients with upper rectal cancer . METHODS : From September 1993 to October 2002 , 153 patients with upper rectal cancer were r and omly assigned to receive either laparoscopic-assisted ( n = 76 ) or open ( n = 77 ) anterior resection .  Patients were last followed up in December 2007 . Long-term morbidity , survival , and disease-free interval were prospect ively recorded . Data were analyzed by intention-to-treat principle . RESULTS : The demographic data of the two groups were comparable . More patients in the open group developed adhesion-related bowel obstruction requiring hospitalization ( P = 0.001 ) and intervention . The overall long-term morbidity rate was also significantly higher in the open group ( P = 0.012 ) . After curative resection , the probabilities of cancer-specific survival at ten years of the laparoscopic-assisted and open groups were 83.5 percent and 78.0 percent , respectively ( P = 0.595 ) , and their probabilities of being disease-free at ten years were 82.9 percent and 80.4 percent , respectively ( P = 0.698 ) . CONCLUSION : Laparoscopic-assisted anterior resection for upper rectal cancer is associated with fewer long-term complications and similar ten-year oncologic outcomes when compared with open surgery 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 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 To assess the safety and efficacy of Seprafilm ( HAL-F ) , Bioresorbable Membrane , ( Genzyme Corporation , Cambridge , MA ) in reducing the incidence , severity , extent , and area of uterine adhesions after myomectomy . DESIGN Prospect i ve , r and omized , blinded , multicenter study . Adhesion reduction was assessed by an independent , blinded , gynecologic surgeon who review ed videotapes of each patient 's second-look laparoscopy . SETTING Nineteen institutions across the United States . PATIENT(S ) One hundred twenty-seven women undergoing uterine myomectomy with at least one posterior uterine incision > or = 1 cm in length . INTERVENTION(S ) Patients were r and omized to treatment with Seprafilm or to no treatment at the completion of the myomectomy . MAIN OUTCOME MEASURE(S ) The incidence , severity , extent , and area of uterine adhesions at second-look laparoscopy . RESULT ( S ) The incidence , measured as the mean number of sites adherent to the uterine surface , was significantly less in treated patients ( 4.98 + /- 0.52 [ mean + /- SEM ] sites ) than in no treatment patients ( 7.88 + /- 0.48 sites ) as were the mean uterine adhesion severity scores ( 1.94 + /- 0.14 versus 2.43 + /- 0.10 ; treatment versus no treatment , respectively ) , mean extent scores ( 1.23 + /- 0.12 versus 1.68 + /- 0.10 ) , and mean area of adhesions ( 13.2 + /- 1.67 versus 18.7 + /- 1.66 cm2 ) . No adverse events occurred that were judged to be related to the use of Seprafilm . CONCLUSION ( S ) In this multicenter study , treatment of patients after myomectomy with Seprafilm significantly reduced the incidence , severity , extent , and area of postoperative uterine adhesions . Additionally , Seprafilm treatment was not associated with an increase in postoperative complications
target: 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
background: 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 .