Reduction in Adhesive Small-Bowel Obstruction by Seprafilm® Adhesion Barrier After Intestinal Resection Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomized, double-blind multicenter study. Evaluation of a new surgical approach for the treatment of clomiphene citrate-resistant infertility in polycystic ovary syndrome: laparoscopic ovarian multi-needle intervention. Influence of small intestinal serosal defect closure on leakage rate and adhesion formation: a pilot study using rabbit models Visceral Sliding Technique Is Useful for Detecting Abdominal Adhesion and Preventing Laparoscopic Surgical Complications Detection of abdominal wall adhesions using visceral slide Bowel obstruction after laparoscopic and open colon resection for cancer: Results of 5 years of follow-up in a randomized trial Gonadotrophin-releasing hormones agonist therapy increases peritoneal fibrinolytic activity and prevents adhesion formation after myomectomy Prevention of Postoperative Abdominal Adhesions by a Novel, Glycerol/Sodium Hyaluronate/Carboxymethylcellulose-Based Bioresorbable Membrane: A Prospective, Randomized, Evaluator-Blinded Multicenter Study Postoperative adhesion prevention with an oxidized regenerated cellulose adhesion barrier in infertile women. Role of microlaparoscopy in the diagnosis of peritoneal and visceral adhesions and in the prevention of bowel injury associated with blind trocar insertion. Role of mitomycin C in reducing adhesion formation following endoscopic sinus surgery. Accuracy of viscera slide detection of abdominal wall adhesions by ultrasound Gonadotropin-releasing hormone agonist pretreatment did not decrease postoperative adhesion formation after abdominal myomectomy in a randomized control trial. Laparoscopy versus laparotomy for ovarian conservative surgery: a randomized trial in the rabbit model. Silastic Splints Reduce Middle Meatal Adhesions after Endoscopic Sinus Surgery Adhesion formation after microlaparoscopic and laparoscopic ovarian coagulation for polycystic ovary disease. The Efficacy of a Novel Chitosan Gel on Hemostasis and Wound Healing after Endoscopic Sinus Surgery Effectiveness of auto-crosslinked hyaluronic acid gel in the prevention of intrauterine adhesions after hysteroscopic surgery: a prospective, randomized, controlled study. Adhesion formation after laparoscopic ovarian cautery for polycystic ovarian syndrome: lack of correlation with pregnancy rate. Prevention of post-surgical adhesion formation using aspirin in a rodent model: a preliminary report. Effects of Intraperitoneal Administration of Simvastatin in Prevention of Postoperative Intra-abdominal Adhesion Formation in Animal Model of Rat. Peritoneal nebulizer: a novel technique for delivering intraperitoneal therapeutics in laparoscopic surgery to prevent locoregional recurrence Non-closure versus closure of peritoneum during cesarean section: a randomized study. Nasal Packing after Septoplasty: A Randomized Comparison of Packing versus no Packing in 88 Patients The placement of peritoneal dialysis catheters: a prospective randomized comparison of open surgery versus “Mini-Perc” technique Anterior abdominal wall adhesions after laparotomy or laparoscopy. Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome. Enterotomy Risk in Abdominal Wall Repair: A Prospective Study Efficacy of a polyethylene oxide-sodium carboxymethylcellulose gel in prevention of intrauterine adhesions after hysteroscopic surgery. Pelvic and periaortic pertioneal closure or non-closure at lymphadenectomy in ovarian cancer: effects on morbidity and adhesion formation. A prospective randomized study of sutured versus stapled bowel anastomoses in patients with cancer Intraperitoneal EMLA (lidocaine/prilocaine) to prevent abdominal adhesion formation in a rat peritonitis model. Evaluation of ovarian adhesion formation after laparoscopic ovarian drilling by second-look minilaparoscopy. Choice of incision in surgical management of small bowel perforations in enteric fever. Mitomycin C for the Prevention of Adhesion Formation after Endoscopic Sinus Surgery: A Randomized, Controlled Study Closure vs non-closure of the visceral and parietal peritoneum at cesarean delivery: 16 year study. The efficacy of a hyaluronate/carboxymethylcellulose membrane in prevention of postoperative adhesion in a rat uterine horn model. Detection of abdominal adhesions in laparoscopic surgery. A controlled study of 130 cases. The effect of oral simvastatin on fibrinolytic activity after colorectal surgery-a pilot study. Long-term outcomes of two different surgical techniques for cesarean. Efficacy of Seprafilm for preventing adhesive bowel obstruction and cost-benefit analysis in pediatric patients undergoing laparotomy.
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 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 Laparoscopic ovarian drilling ( LOD ) is the accepted second-line treatment for clomiphene citrate-resistant anovulatory infertility in polycystic ovary syndrome ( PCOS ) . Although multiple pregnancy rates are reduced with ovarian drilling procedures , postoperative adhesion formation is a potential complication in up to 85 % of the women subjected to laparoscopic destructive ovarian procedures . Our objective was to determine the effectiveness of a new , specially design ed laparoscopic device and technique that might enable treatment for patients with anovulatory PCOS with less trauma and fewer postoperative adhesions . Thirty-five infertile clomiphene citrate-resistant women with PCOS were included . Seventeen women underwent laparoscopic ovarian multi-needle intervention ( LOMNI ) , and 18 women received step-up ovulation induction treatment with recombinant follicle-stimulating hormone followed by intrauterine insemination for three cycles . Patients were followed for a period of 6 months after either laparoscopic surgery or the initiation of ovulation induction therapy . Outcome measures were cycle regularity , pregnancy rate , safety , postoperative adhesion formation , and cost effectiveness . There were no significant differences between the two groups in terms of age , body-mass index , duration of infertility , and basal cycle-day 2 hormone levels . Significant improvement in cycle regularity ( p < .01 ) was found after LOMNI .  Cumulative pregnancy rates ( 35.3 % in the LOMNI group vs 33.3 % in the ovulation induction group ) did not differ between the groups . No adverse events following surgery were noted . Moderate ovarian hyperstimulation syndrome and multiple pregnancies occurred in four and two patients , respectively , in the ovulation induction group . Eight nonpregnant women in the LOMNI group underwent repeat laparoscopy at the end of the follow-up period . No adhesion formation attributable to LOMNI was observed in any of those eight women . The cost of LOMNI was significantly ( p < .001 ) lower than the ovulation induction treatment . In conclusion , LOMNI may be a safe , inexpensive , and effective procedure for the treatment of CC-resistant infertility in patients with PCOS . It seems to preserve the beneficial effects and probably omits unwanted effects ( such as adhesion formation ) of LOD 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 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 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 Postoperative bowel obstruction caused by intra-abdominal adhesions occurs after all types of abdominal surgery . It has been suggested that the laparoscopic technique should reduce the risk for adhesion formation and thus for postoperative bowel obstruction . This study was design ed to compare the incidence of bowel obstruction in a r and omized trial where laparoscopic and open resection for colon cancer was compared . Methods A retrospective analysis was performed , collecting data of episodes of bowel obstruction with or without surgery . Only episodes treated in the hospital where the index surgery took place were included . Data for 786 patients were collected for the 5-year period after cancer surgery . Results Baseline characteristics for the evaluated laparoscopic ( n = 383 ) and open ( n = 403 ) groups were comparable . The cumulative obstruction percentages at 5 years for the open and laparoscopic groups were 6.5 and 5.1 % respectively and did not significantly differ from each other . Tumor stage seemed to influence the risk for bowel obstruction : 2.8 % in stage I , 6.6 % in stage II , and 7 % in stage III , but the differences were not significant . Conclusions This analysis does not support the hypothesis that laparoscopy leads to fewer episodes of bowel obstruction compared with open surgery 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 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 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 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 study the role of mitomycin C in reducing adhesion formation following endoscopic sinus surgery . STUDY DESIGN Prospect i ve , r and omized , controlled trial . SETTING Tertiary care referral centre . PATIENTS Thirty patients were selected suffering long-term problems with bilateral chronic rhinosinusitis , with no relief obtained from medical therapy . Patients requiring revision sinus surgery or having acute upper respiratory tract infection were excluded . INTERVENTIONS Diagnostic nasal endoscopies and non-contrast computerized tomography of nose and paranasal sinuses were undertaken and , following confirmation of the diagnosis , functional endoscopic sinus surgery ( FESS ) was carried out bilaterally using the Messerklinger technique . On completion of the surgery , a cotton wick soaked in mitomycin C was placed in one or other side of the nose in the middle meatus . Follow up was for three months and patients were assessed for subjective and objective improvement in their symptoms . RESULTS Post-operatively , of the 11 ( 36.6 per cent ) patients complaining of persistent nasal obstruction , nine had complaints limited to the control side only ( p=0.005 ) . Out of the nine ( 30 per cent ) patients complaining of recurrent nasal discharge , eight had complaints on the control side and only one reported discharge from both sides ( p=0.006 ) . CONCLUSION Mitomycin C may be topically applied in post-operative FESS cases to reduce adhesion formation and hence the need for revision surgery Viscera slide is the normal , longitudinal movement of the intraabdominal viscera caused by respiratory excursions of the diaphragm . By detecting areas of restricted viscera slide , ultrasonic imaging was used to identify anterior abdominal wall adhesions prior to laparotomy or laparoscopy . Transcutaneous ultrasound examination was performed on 110 patients . A prediction of adhesions was made for each patient and then compared to the findings during subsequent laparotomy or laparoscopy .  Only patients with previous abdominal surgery or history of peritonitis demonstrated adhesions . Sensitivity and specificity of viscera slide ultrasound in predicting adhesions were 90 % and 92 % . Nine out of 10 false results involved misinterpretation of ultrasound images of the lower one-third of the abdomen . Ultrasonic imaging of viscera slide is highly accurate in detecting abdominal wall adhesions . This technique is most useful in guiding the insertion of trocar in laparoscopic surgery , and as a noninvasive method in study ing the formation of adhesions OBJECTIVE To determine if 3 months of preoperative gonadotropin-releasing hormone agonist ( GnRH-a ) treatment decreases postoperative uterine adhesions after open abdominal surgery for the removal of uterine fibroids . DESIGN Prospect i ve , r and omized , clinical study . SETTING A tertiary care medical center . PATIENT(S ) Women of reproductive age with symptomatic uterine fibroids not amenable to hysteroscopic removal . INTERVENTION(S ) Twenty patients underwent an initial abdominal myomectomy followed by a second-look laparoscopy  for evaluating uterine adhesions after r and om allocation to groups receiving either GnRH analog or placebo for 3 months before the initial surgery . MAIN OUTCOME MEASURE(S ) Adhesion formation between treatment groups and by incision number and aggregate length . RESULT ( S ) Presurgical GnRH-a treatment did not decrease adhesion formation compared with placebo . For every additional centimeter of incision length , the total adhesion area over the uterine serosal surface increased by 0.55 cm(2 ) . The number of myomas removed and the number of incisions were positively correlated with total adhesion area . CONCLUSION ( S ) Preoperative treatment with GnRH-a for 3 months before open abdominal myomectomy did not decrease postoperative uterine adhesions . Following the st and ards of good surgical technique , adhesions are minimized with fewer and smaller incisions 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 Background Adhesions frequently form between the middle turbinate and lateral nasal wall after  endoscopic sinus surgery ( ESS ) and are a possible cause for surgical failure . Many absorbable and nonabsorbable spacers have been tried to improve healing . This study was design ed to ascertain whether placement of a thin silastic splint into the middle meatus after sinus surgery for 2 weeks reduces adhesion formation and whether a reduction in the adhesion rate improves patient outcomes in the early postoperative phase . Methods Forty-two patients who were scheduled to undergo ESS for chronic rhinosinusitis were r and omized to have a silastic splint placed into the middle meatus on one side of the nose but not the other at the completion of surgery . Splints were removed 2 weeks postoperatively . Symptom scores were recorded for each side of the nose up to 12 weeks after surgery and ethmoid cavities were grade d at the 6- and 12-week visits along with assessment of adhesions . Patients were blinded to which side was splinted as was the surgeon assessing ethmoid cavities at 6 and 12 weeks . Results Thirty-three patients completed 12 weeks of follow-up . Nasal obstruction and facial pain/discomfort were significantly higher on splinted sides for the first 2 weeks . More interventions were performed to debride adhesions in nonsplinted sides . Endoscopy revealed no adhesions at 12 weeks for sides treated with a splint whereas 9 of 33 nonsplinted sides had persistent adhesions . There were no significant differences in symptom or ethmoid cavity scores at 6 or 12 weeks between sides treated with splints versus sides treated without splints or between sides with adhesions versus without adhesions . Conclusion Middle meatal silastic splints reduce adhesions after ESS but increase early nasal obstruction and discomfort . Their use did not significantly change symptom or ethmoid cavity scores at 12 weeks 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 Postoperative bleeding and adhesion formation are the two most common complications after endoscopic sinus surgery ( ESS ) . Continued bleeding risks airway compromise from the inhalation of blood clots and from the aspiration of blood-stained vomitus . Additionally , adhesion formation is the most common reason for patients requiring revision surgery . This study aim ed to determine the efficacy of a novel chitosan/dextran ( CD ) gel on hemostasis and wound healing after ESS . Methods A r and omized controlled trial was performed involving 40 patients undergoing ESS for chronic rhinosinusitis . Immediately after surgery a baseline Boezaart Surgical Field Grading Scale was taken . Computer r and omization was performed with one side receiving CD gel and the other side receiving no treatment ( control ) . Boezaart bleeding scores were then calculated for each side every 2 minutes . Patient 's endoscopic features of wound healing were assessed at 2 , 6 , and 12 weeks after surgery . Results CD gel  achieved rapid hemostasis with the mean time to hemostasis at 2 minutes ( 95 % CI , 2–4 minutes ) compared with 10 minutes ( 95 % CI , ≥6 minutes ) for the control ( p < 0.001 ) . There were significantly less adhesions at all time points with CD gel versus control : 2 versus 18 at 2 weeks ( p < 0.001 ) , 3 versus 16 at 6 weeks ( p < 0.001 ) , and 2 versus 12 at 3 months ( p < 0.001 ) . There was no significant difference between CD gel and control with respect to crusting , mucosal edema , infection , or granulation tissue formation . Conclusions CD gel is rapidly hemostatic immediately after ESS and prevents adhesion formation , addressing two of the most common complications of sinus surgery BACKGROUND A prospect i ve , r and omized , controlled study was performed to assess the efficacy of auto-crosslinked hyaluronic acid ( ACP ) gel to prevent the development of de-novo intrauterine adhesions following hysteroscopic surgery . METHODS One hundred and thirty-two patients with a single surgically remediable intrauterine lesion ( myomas , polyps and uterine septa , subgroups I-III ) completed the study . Patients were r and omized to two different groups : group A underwent hysteroscopic surgery plus intrauterine application of ACP gel ( 10 ml ) while group B underwent hysteroscopic surgery alone ( control group ) . The rate of adhesion formation and the adhesion score was calculated for each group and subgroup 3 months after surgery . RESULTS Group A showed a significant reduction in the development of de-novo intrauterine adhesions at 3 months follow-up in comparison with the control group . Furthermore , the staging of adhesions showed a significant decrease in adhesion severity in patients treated with ACP gel . CONCLUSIONS ACP gel significantly reduces the incidence and severity of de-novo formation of intrauterine adhesions after hysteroscopic 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 Pelvic adhesions are one of the major factors which significantly and adversely affect surgery outcome due to intra- and postoperative morbidity and reduce future female fertility . Using a rodent model , we evaluated the efficacy of aspirin , a non-steroidal anti-inflammatory drug , in the prevention of adhesion formation . A total of 72 female Wistar rats received a st and ardized primary traumatic lesion to the right uterine horn . They were r and omly divided into eight groups : group I ( control ) had no treatment and group II received a single pre-operative 0.70 mg aspirin . All the succeeding groups ( III-VIII ) received aspirin in doses of 0.35 , 0.70 , or 1.40 mg every 6 h for either 48 or 96 h in addition to the pre-operative aspirin ( 0.70 mg ) . All animals were killed 4 weeks later and adhesions were assessed using a modified adhesion scoring scale . The lowest adhesion score was found in the group treated with 0.35 mg of aspirin for 96 h , and the highest was found among the groups treated with either 0.70 or 1.40 mg for 48 - 96 h respectively ( P < 0.05 ) . These results are in line with the hypothesis that administration of a low dose of aspirin selectively inhibits the production of thromboxane A2 , whereas basal prostacyclin bio synthesis is preserved . This phenomenon might contribute to reducing postoperative adhesion formation in a rat model . Thus , future studies into the prevention of adhesion formation may require the additional use of a non-steroidal anti-inflammatory drug , for which aspirin deserves further attention , before extrapolation into human therapy OBJECTIVE To determine the preventive effects of local administration of simvastatin for postoperative intra-abdominal adhesion formation in animal model of rat . METHODS In this experimental study , 32 Wistar albino rats as the animal model of intra-abdominal adhesion formation were included . Adhesions were induced in all the animals via abrasion of the peritoneal and intestinal surface during laparotomy . Afterwards , the rats were r and omly assigned to receive simvastatin ( 30 mg/kg body weight ) as a single intraperitoneal dose at the time of laparotomy ( n=16 ) or normal saline in same volume at the same time ( n=16 ) . At the day 21 , animals were euthanized and the adhesions were quantified clinical ly ( via repeated laparotomy ) and pathologically and compared between the two groups . RESULTS The baseline characteristics of the animals were comparable between two study groups . Clinical ly , in simvastatin group , 10 rats ( 62.5 % ) did not develop any adhesion and 6 ( 37.5 % ) had first- grade adhesion ; whereas in the control group , 11 ( 68.8 % ) rats had first- and 5 ( 31.2 % ) had second- grade adhesions ( p<0.001 ) . Pathologically , in simvastatin group , 6 rats ( 37.5 % ) had first- grade adhesion , while in control group , 11 rats ( 68.8 % ) had first- and 5 ( 31.2 % ) had second- grade adhesions ( p<0.001 ) . CONCLUSION Our findings suggest that intraperitoneal administration of simvastatin is an effective method for prevention of postoperative intra-abdominal adhesion formation in animal model of rat Background Peritoneal involvement is a significant issue in the treatment of gastrointestinal malignancies . Current statistics indicate that after surgical intervention , up to 20 % of patients will present with locoregional metastasis . The ability to inhibit initial tumor adhesion to the mesothelial lining of the peritoneum may be considered critical in the inhibition of tumor development . This article describes , the use of a novel nebulizer system capable of delivering high-concentration , low-dose therapeutics to the peritoneal cavity . Methods For this study , 30 male WAG rats were inoculated with CC531 colorectal tumor cells . The rats were r and omized into three groups : control group ( n = 10 ) , heparin-treated group ( n = 10 ) , and high-molecular-weight hyaluronan-treated group ( n = 10 ) . A peritoneal cancer index was used to determine tumor burden at 15 days . Analysis of variance ( ANOVA ) was used to compare multiple group means . Results Nebulization therapy was performed without any complication in the cohort . Heparin inhibited macroscopic intraperitoneal tumor growth completely ( p = 0.0001 ) without affecting tumor cell viability . The introduction of hyaluronan attenuated both tumor size and distribution , was compared with the control group ( p = 0.002 ) . Conclusion Nebulized heparin and hyaluronic acid using a novel nebulization technique attenuates peritoneal tumor growth after laparoscopic surgery . The technique itself is easy to use and safe 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 once-common practice of packing the nose  after septoplasty  was based on a desire to prevent postoperative complications such as bleeding , septal hematoma , and adhesion formation . However , it was since found that not only is nasal packing ineffective in this regard , it can actually cause these complications . Although the consensus in the world literature is that packing should be avoided , to the best of our knowledge , no truly r and omized study has been undertaken in Southwest Asia upon which to justify this recommendation here . Therefore , we conducted a prospect i ve r and omized comparison of the incidence of a variety of postoperative signs and symptoms in 88 patients , 15 years of age and older , who did ( n = 44 ) and did not ( n = 44 ) undergo nasal packing following septoplasty .  We found that the patients who underwent packing experienced significantly more postoperative pain , headache , epiphora , dysphagia , and sleep disturbance on the night of surgery . Oral and nasal examinations 7 days postoperatively revealed no significant difference between the two groups in the incidence of bleeding , septal hematoma , adhesion formation , and local infection . Finally , the packing group reported a moderate to high level of pain during removal of the packing . Our findings confirm that nasal packing after septoplasty is not only unnecessary , it is actually a source of patient discomfort and other signs and symptoms Purpose Currently , most ESRD patients are treated with open surgical technique or with laparoscopic technique . In this study , we examined the role of the ureteroscope-assisted “ Mini-Perc ” technique versus the modified open surgery in the treatment of ESRD in a prospect i ve r and omized manner . Methods A total of 72 patients with chronic renal failure were prospect ively r and omized for the ureteroscope-assisted “ Mini-Perc ” technique or modified open surgery .  Intraoperative and postoperative morbidity , incision size , dose of local anesthesia , operative time , hospital stay , and initial catheter survival and follow-up were compared for both methods . Results “ Mini-Perc ” group was associated with shorter incision size , operative time , and hospital stay , with lower dose of local anesthesia and incidence of bloody ascites . Two of five patients with the history of abdominal surgery in “ Mini-Perc ” group required adhesiolysis under direct vision of telescope . All adhesions were easily dissected . All complications of leakage ( 8.1 % ) and incisional hernia ( 2.7 % ) occurred in the open surgery group , but a difference of no significant value with “ Mini-Perc ” group ( p = 0.2400 , p = 1.0000 ) . There was no any other significant difference in common complications between two groups . After 2 years of follow-up , 54 patients ( 75 % ) survived with their initial PD catheter . The overall death was 5 ( 6.9 % ) . Conclusions Compared to modified open surgical technique , the ureteroscope-assisted “ Mini-Perc ” technique can be used to achieve the same clinical efficacy for placement of peritoneal dialysis catheters in ESRD patients , and it carries minimal morbidity 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 AIM To identify and analyze the clinical presentation , management and outcome of patients with acute mechanical bowel obstruction along with the etiology of obstruction and the incidence and causes of bowel ischemia , necrosis , and perforation . METHODS This is a prospect i ve observational study of all adult patients admitted with acute mechanical bowel obstruction between 2001 and 2002 . RESULTS Of the 150 consecutive patients included in the study , 114 ( 76 % ) presented with small bowel and 36 ( 24 % ) with large bowel obstruction . Absence of passage of flatus ( 90 % ) and /or feces ( 80.6 % ) and abdominal distension ( 65.3 % ) were the most common symptoms and physical finding , respectively . Adhesions ( 64.8 % ) , incarcerated hernias ( 14.8 % ) , and large bowel cancer ( 13.4 % ) were the most frequent causes of obstruction . Eighty-eight patients ( 58.7 % ) were treated conservatively and 62 ( 41.3 % ) were operated ( 29 on the first day ) . Bowel ischemia was found in 21 cases ( 14 % ) , necrosis in 14 ( 9.3 % ) , and perforation in 8 ( 5.3 % ) . Hernias , large bowel cancer , and adhesions were the most frequent causes of bowel ischemia ( 57.2 % , 19.1 % , 14.3 % ) , necrosis ( 42.8 % , 21.4 % , 21.4 % ) , and perforation ( 50 % , 25 % , 25 % ) . A significantly higher risk of strangulation was noticed in incarcerated hernias than all the other obstruction causes . CONCLUSION Absence of passage of flatus and /or feces and abdominal distension are the most common symptoms and physical finding of patients with acute mechanical bowel obstruction , respectively . Adhesions , hernias , and large bowel cancer are the most common causes of obstruction , as well as of bowel ischemia , necrosis , and perforation . Although an important proportion of these patients can be nonoperatively treated , a substantial portion requires immediate operation . Great caution should be taken for the treatment of these patients since the incidence of bowel ischemia , necrosis , and perforation is significantly high 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 STUDY OBJECTIVES To assess the efficacy of a polyethylene oxide-sodium carboxymethylcellulose gel ( Intercoat ; Gynecare , division of Ethicon , Inc. , Somerville , NJ ) in preventing the development of de novo intrauterine adhesions ( IUAs ) after hysteroscopic surgery and to rate the patency of the internal uterine ostium at 1-month follow-up diagnostic hysteroscopy . DESIGN R and omized controlled study ( Canadian Task Force classification I ) . SETTING University hospital . PATIENTS One hundred ten patients diagnosed during office hysteroscopy as having single or multiple lesions suitable for surgical treatment or resistant dysfunctional uterine bleeding requiring endometrial ablation . INTERVENTIONS Patients were r and omized to 2 groups . Group 1 underwent hysteroscopic surgery plus intrauterine application of Intercoat gel , and group 2 underwent hysteroscopic surgery only ( control group ) . Follow-up office hysteroscopy was performed at 1 month after surgery to assess the rate and severity of IUA formation and to rate the patency of the internal uterine ostium after the surgical intervention . MEASUREMENTS AND MAIN RESULTS Compared with the group 2 , group 1 demonstrated a significant reduction in the incidence ( 6 % vs 22 % ; p < .05 ) of de-novo IUAs . Application of the gel seemed to reduce the severity of IUAs , with fewer moderate and severe IUAs at follow-up in group 1 in comparison with group 2 ( 33 % vs 92 % ) . Furthermore , group 1 demonstrated significant improvement in the degree of patency of the internal uterine ostium ( 41.9 % of cases ) in comparison with diagnostic office hysteroscopy performed at enrollment ( p < .05 ) . In contrast , in group 2 , worsening of patency of the internal uterine ostium was recorded in 18.2 % of cases ( p < .05 ) . CONCLUSIONS Intercoat gel seems to prevent de novo formation of IUAs and to improve the patency of the internal uterine ostium at follow-up hysteroscopy . However , larger studies are needed to confirm these findings 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 Eighty‐eight cancer patients with the presence of one or more adverse factors for healing ( carcinomatosis , adhesions , prior chemotherapy and radiation therapy , bowel obstruction , anemia , and low leukocyte count or albumin value ) were prospect ively r and omized to undergo conventional two‐layer h and suturing ( 45 patients ) or mechanical stapling with a GIA/TA instrument ( U. S. Surgical Corp. , Norwalk , CT ) ( 43 patients ) of the large or small bowel anastomosis . Age , sex , complete blood count findings , and all biochemical plasma values were comparable in both groups . The anastomosis took an average of 19 minutes for the sutured and 9 minutes for the stapled technique ( P = 0.0001 ) , but the average length of operation , postoperative return of bowel function , and hospital stay were comparable in both groups . Bowel fistula was seen in one case of stapled anastomosis ( P = not significant ) . The pulmonary and wound complication rates were the same in both groups . Of the four deaths ( 4.5 % ) due to causes unrelated to bowel anastomosis , three occurred in the stapled and one in the sutured group . It was concluded that a stapled anastomosis is as safe as a sutured one in patients with advanced‐stage cancer . It saves time in anastomosis , but does not save time in postoperative return of the bowel function and hospital stay OBJECTIVE The accelerative effect of EMLA ( eutectic mixture of lidocaine 2.5 % and prilocaine 2.5 % ) in the wound healing process is known . We hypothesised that post-operative peritoneal adhesions may be reduced with intra-peritoneal EMLA administration in a model of bacterial peritonitis . STUDY DESIGN Bacterial peritonitis was induced in 24 rats by cecal ligation and puncture . The rats were r and omly assigned to one of four groups . Group 1 ( n=6 ) ) received EMLA intraperitoneally , group 2 ( n=6 ) received 2 % lidocaine hcl solution intraperitoneally , the third group received one dose ( 100 mg/kg ) of ceftriaxone sodium ( Rocephin , Roche , 1 g ) intraperitoneally one day after cecal ligation and puncture procedure , and in control group ( group 4 , n=6 ) , no fluid or medicine was introduced into the abdomens of the rats . All animals were killed 14 days later in order to assess the adhesion score . Tissue antioxidant levels were measured in 1 g tissue sample s taken from the abdominal wall . RESULTS The adhesion score was significantly lower in the EMLA group than in the lidocaine and control groups . The catalase levels were higher in the lidocaine and control groups than in EMLA group . CONCLUSIONS Intraperitoneal EMLA inhibited the formation of postoperative intra-abdominal adhesions without compromising the wound healing in this bacterial peritonitis rat model . EMLA also decreased the oxidative stress during peritonitis ( Tab . 1 , Fig. 7 , Ref . 27 ) . Full Text ( Free , PDF ) www.bmj.sk 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 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 : Mitomycin C ( MMC ) is an antineoplastic agent that has been shown to decrease scar tissue after ophthalmologic surgery . Our goal was to determine whether the application of MMC at the conclusion of sinus surgery decreases the incidence of postoperative adhesion formation . METHODS : At the completion of endoscopic sinus surgery in 55 patients , a cotton pledget saturated with 1 mL of 0.4 mg/mL MMC was placed for 4 minutes in the right or left middle meatus and a similar saline-soaked pledget was placed on the opposite side . Patients were examined postoperatively by a masked observer for the presence of synechiae and mucosal changes . RESULTS : Postoperative adhesions were observed in 16 patients ( 29 % ) with a mean follow-up of 4.1 months . These adhesions were bilateral in 6 patients ( 10.9 % ) and unilateral in 10 patients ( 18 % ) . Unilateral adhesions were observed on only 2 sides ( 3.6 % ) treated with MMC and 8 controls ( 14.5 % ) ( P = 0.058 ) . No adverse effects were observed . CONCLUSIONS : MMC was found to be safe to use during sinus surgery , and it may reduce the incidence of postoperative adhesions at the dosage used in this study . SIGNIFICANCE : Because of the observed trend toward decreased synechiae formation with MMC application , further trials using higher concentrations and application times are warranted 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 The current study was design ed to investigate the efficacy of a hyaluronate/carboxymethylcellulose membrane for the prevention of post-operative adhesion in a rat uterine horn model . This is a prospect i ve double-blinded controlled study . Nineteen injured uterine horns were treated with a hyaluronate/carboxymethylcellulose membrane as a barrier and 19 injured uterine horns without any treatment served as a control group . Two weeks later , second look laparotomies were performed in order to assess the degree of the adhesion . Total adhesion scores , histopathological analysis of inflammation process and vascularization of adhesions were compared with control group . P values of 5 % or less were considered statistically significant . Animals treated with a hyaluronate/carboxymethylcellulose membrane had significantly reduced post-surgical adhesion scores when compared with control group . In histopathological examination , there was less vascularization in the treatment group . The types and extent of inflammation were similar in two groups . Clinical ly and histopathologically , a hyaluronate/carboxymethylcellulose membrane is effective in reducing postoperative adhesion formation in the rat uterine horn model 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 BACKGROUND Studies conducted in animal models have shown that statins ( 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors ) reduce adhesion formation by upregulating fibrinolysis . The aim of this study was to determine the effect of orally administered statins on the promoters and inhibitors of the fibrinolytic pathway . METHODS In a previously described double-blinded clinical trial , 144 patients undergoing elective colorectal resection , or reversal of Hartmann 's procedure were r and omized to receive 40 mg once daily oral simvastatin 3 - 7 d before surgery or placebo . For the purpose s of the present study , peritoneal drain fluid was collected postoperatively from patients to measure active tissue plasminogen activator ( tPA ) , tissue plasminogen activator total antigen , active plasminogen activator inhibitor-1 ( PAI-1 ) , plasminogen activator inhibitor total antigen ( PAI-1TA ) , plasminogen activator inhibitor-1 and tissue plasminogen activator complex ( PAI-1/tPA ) . These were analyzed using ELISA . The number of hospitalizations and complications related to small bowel obstruction ( SBO ) were recorded at 2 y after surgery . RESULTS A total of 95 patients ( 72 % ) had sufficient peritoneal drain fluid suitable for ELISA analysis . Of them , 46 patients ( 48 % ) were from the oral simvastatin group . Mean tPA and tPA total antigen concentrations in peritoneal fluid were similar between the two groups . Mean PAI-1 and PAI-1 TA concentrations in the statin and placebo group were also similar . Mean PAI-1/tPA complex concentration was similar between the two groups . The number of hospitalizations from SBOs were 5 and 4 in the statin and placebo groups respectively ( P = 0.46 ) . The overall mortality at 2-year post-surgery was similar between the two groups ( P = 0.59 ) . CONCLUSIONS In this pilot study involving humans , oral simvastatin had no measured effect on the peritoneal fibrinolytic pathway in the first 24 h after colorectal surgery . Analysis of clinical outcomes also showed that oral simvastatin did not reduce hospitalizations for SBO in the 2 y after surgery . Further studies may be useful to evaluate whether fibrinolytic pathways beyond 24 h are altered after systemic administration of statins and to evaluate the use of higher doses of statins , perhaps used intraperitoneally rather than systemically 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 PURPOSE This aim of the study is to determine whether the use of Seprafilm reduces the incidence and the medical costs of  adhesive bowel obstruction ( ABO ) in children . METHODS Pediatric patients undergoing laparotomy were prospect ively assigned to the Seprafilm group , n = 441 ) . A historical control group consisted of children without using Seprafilm ( n = 409 ) . The incidence of ABO during a 24-month follow-up period was compared between the groups . To clarify the cost-benefit relations , expenses for  Seprafilm  and medical costs for hospitalization related to ABO in the Seprafilm group were compared with the ABO-associated hospitalization costs in the control group . RESULTS The cumulative incidence rate of ABO in the control group was significantly higher than in the Seprafilm group ( 4.9 % vs. 2.0 % , p = 0.015 ) . Nearly all cases that required adhesiolysis had adhesions to areas other than the incision in both groups . In cost-benefit analysis , cost per patient was $ 105 higher in the control group than in the Seprafilm group , but this did not reach significance ( p = 0.63 ) . CONCLUSIONS Seprafilm reduces the incidence of ABO in the pediatric patients undergoing laparotomy . Although associated medical costs in the Seprafilm group were not significantly reduced , use of Seprafilm did not lead to an increase in cost . Wider range of Seprafilm application or an additional anti-adhesion device may help in preventing adhesion to areas other than the incision
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 .