Different surgical techniques to reduce post-operative adhesion formation: a systematic review and meta-analysis

作者：ten Broek R P G; Kok Krant N; Bakkum E A; Bleichrodt R P; van Goor H^*

来源：Human Reproduction Update, 2013, 19(1): 12-25.

DOI：10.1093/humupd/dms032

• tissue adhesions
• laparoscopy
• peritoneal closure
• infertility
• small bowel obstruction

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 ogood surgical technique%26apos; is advocated as a first step in preventing adhesions. However, the evidence for different surgical techniques to reduce adhesion formation needs confirmation. %26lt;br%26gt;Pubmed, Embase and CENTRAL were searched to identify randomized controlled trials that investigated the effect of various aspects of surgical technique on adhesion-related outcomes. Clinical outcomes and incidence of adhesions were the primary endpoints. Identification of papers and data extraction were performed by two independent researchers. %26lt;br%26gt;There were 28 papers with 27 studies included for a systematic review. Of these, 17 studies were eligible for meta-analysis and 11 for qualitative assessment only. None of the techniques that were compared significantly reduced the incidence of adhesive small bowel obstruction. In a small low-quality trial, the pregnancy rate increased after subserous fixation of suture knots. However, the incidence of adhesions was lower after laparoscopic compared with open surgery [relative risk (RR) 0.14; 95 confidence interval (CI): 0.030.61] and when the peritoneum was not closed (RR 0.36; 95 CI: 0.210.63). %26lt;br%26gt;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.

• 出版日期2013-2