Fewer adhesions induced by laparoscopic surgery?

  • C. N. Gutt
  • T. Oniu
  • P. Schemmer
  • A. Mehrabi
  • M. W. Büchler
Review article

Abstract

Background

Laparoscopic surgery has potential theoretical advantages over open surgery in reducing the rate of adhesion formation, but very few comparative studies are available to prove this.

Methods

A literature search was performed within Medline and Cochrane databases using the key words: adhesion*, adhesiolysis, laparoscop*, laparotomy, open surgery. Further articles were identified from the reference lists of retrieved literature. Both clinical and experimental studies comparing laparoscopy and laparotomy with regard to adhesion formation were retained. In each article, the rates of adhesion formation were identified or deduced for the operative site, access wound site, and distant sites.

Results

Fifteen studies from 1987 to 2001 were identified. Most studies assessed the operative site. Thus, three clinical studies and six experimental ones found fewer adhesions following laparoscopy than laparotomy, while other five experimental studies found similar adhesion rates for the two surgical methods. There were fewer adhesions to trocar wounds than to the laparotomy wounds in seven studies and equal rates of adhesion in one study. The problem of distant adhesions is poorly represented in literature; three studies favored laparoscopy as being followed by fewer adhesions. Because of the important differences between studies with regard to the design, end points, and statistical calculations, a metaanalysis could not be achieved. The conclusion is based on the prevalence of evidence.

Conclusions

All clinical studies and most of the experimental studies found a reduction of adhesion formation after laparoscopic surgery compared to open surgery.

Keywords

Adhesion Adhesion formation Adhesion reformation Adhesiolysis Laparoscopy Laparoscopic adhesiolysis 

References

  1. 1.
    American Fertility, Society 1988The AFS classification of adnexal adhesions.Fertil Steril49944955PubMedGoogle Scholar
  2. 2.
    Audebert, AJ, Gomel, V 2000Role of microlaparoscopy in the diagnosis of peritoneal and visceral adhesions and in the prevention of bowel injury associated with blind trocar insertion.Fertil Steril73631635CrossRefPubMedGoogle Scholar
  3. 3.
    Beck, DE, Opelka, FG, Bailey, HR, Rauh, SM, Pashos, CL 1999Incidence of small-bowel obstruction and adhesiolysis after open colorectal and general surgery.Dis Colon Rectum42241248PubMedGoogle Scholar
  4. 4.
    Burns, JW, Colt, MJ, Burgees, LS, Skinner, KC 1997Preclinical evaluation of Seprafilm bioresorbable membrane.Eur J Surg Suppl5774048PubMedGoogle Scholar
  5. 5.
    Chamberlain, GBrown, JC eds. 1978Gynecological laparoscopy: report on the confidential enquiry into gynecological laparoscopy.Royal College of Obstetricians and GynecologistsLondonGoogle Scholar
  6. 6.
    Chen, MD, Teigen, GA, Reynolds, HT, Johnson, PR, Fowler, JM 1998Laparoscopy versus laparotomy: an evaluation of adhesion formation after pelvic and paraaortic lymphadenectomy in a porcine model.Am J Obstet Gynecol178499503PubMedGoogle Scholar
  7. 7.
    Garza-Villasenor, L 2001Etiology of intestinal occlusion.Rev Gastroenterol Mex66193196PubMedGoogle Scholar
  8. 8.
    Diamond, MP, El-Mowafi, DM 1998Pelvic adhesions.Surg Technol IntVII273283PubMedGoogle Scholar
  9. 9.
    Drollette, CM, Badaway, SZA 1992Pathophysiology of pelvic adhesions.J Reprod Med37107121PubMedGoogle Scholar
  10. 10.
    Ellis, H 1997The clinical significance of adhesions: focus on intestinal obstruction.Eur J Surg Suppl57759PubMedGoogle Scholar
  11. 11.
    Ellis, H 1982The causes and prevention of intestinal adhesions.Br J Surg69241243PubMedGoogle Scholar
  12. 12.
    Ellis, H, Moran, BJ, Thompson, JN, Parker, MC, Wilson, MS, Menzies, D, McGuire, A, Lower, AM, Hawthorn, RJ, O’Brien, F, Buchan, S, Crowe, AM 1999Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study.Lancet35314761480PubMedGoogle Scholar
  13. 13.
    Filmar, S, Gomel, V, McComb, PF 1987Operative laparoscopy versus open abdominal surgery: a comparative study on postoperative adhesion formation in the rat model.Fertil Steril48486489PubMedGoogle Scholar
  14. 14.
    Garrard, CL, Clements, RH, Nanney, L, Davidson, JM, Richards, WO 1999Adhesion formation is reduced after laparoscopic surgery.Surg Endosc131013CrossRefPubMedGoogle Scholar
  15. 15.
    Hazebroek, EJ, Schreve, MA, Visser, P, Bruin, RW, Marquet, RL, Bonjer, HJ 2002Impact of temperature and humidity of carbon dioxide pneumoperitoneum on body temperature and peritoneal morphology.J Laparoendosc Adv Surg Tech A12355364CrossRefPubMedGoogle Scholar
  16. 16.
    Holmdahl, L, Eriksson, E, Eriksson, BI, Risberg, B 1998Depression of peritoneal fibrinolysis during operation is a local response to trauma.Surgery123539544PubMedGoogle Scholar
  17. 17.
    Hulka, JF 1982Adnexal adhesions: a prognostic staging and classification system based on a five-year survey of fertility surgery results at Chapel Hill, North Carolina.Am J Obstet Gynecol144141148PubMedGoogle Scholar
  18. 18.
    Ivarsson, ML, Holmdahl, L, Franzen, G, Risberg, B 1997Cost of bowel obstruction resulting from adhesions.Eur J Surg163679684PubMedGoogle Scholar
  19. 19.
    Jorgensen, JO, Lalak, NJ, Hunt, DR 1995Is laparoscopy associated with a lower rate of postoperative adhesions than laparotomy? A comparative study in the rabbit.Aust N Z J Surg65342344PubMedGoogle Scholar
  20. 20.
    Kränenbühl, L, Schafer, M, Kuzinkovas, V, Renzulli, P, Baer, HU, Buchler, MW 1998Experimental study of adhesion formation in open and laparoscopic fundoplication.Br J Surg85826830CrossRefPubMedGoogle Scholar
  21. 21.
    Kuruvilla, MJ, Chhallani, CR, Rajagopal, AK, Salem Rakas, F 1987Major causes of intestinal obstruction in Libya.Br J Surg74314315PubMedGoogle Scholar
  22. 22.
    Luciano, AA, Maier, DB, Koch, EI, Nulsen, JC, Whitman, GF 1989A comparative study of postoperative adhesions following laser surgery by laparoscopy versus laparotomy in the rabbit model.Obstet Gynecol74220224PubMedGoogle Scholar
  23. 23.
    Luijendijk, RW, Lange, DC, Wauters, CC, Hop, WC, Duron, JJ, Pailler, JL, Camprodon, BR, Holmdahl, L, Geldorp, HJ, Jeekel, J 1996Foreign material in postoperative adhesions.Ann Surg223242248CrossRefPubMedGoogle Scholar
  24. 24.
    Lundorff, P, Hahlin, M, Kallfelt, B, Thorburn, J, Lindblom, B 1991Adhesion formation after laparoscopic surgery in tubal pregnancy: a randomized trial versus laparotomy.Fertil Steril55911915PubMedGoogle Scholar
  25. 25.
    Lundorff, P, Geldorp, H, Tronstad, SE, Lalos, O, Larsson, B, Johns, DB, diZerega, GS 2001Reduction of post-surgical adhesions with ferric hyaluronate gel: a European study.Hum Reprod1619821988Google Scholar
  26. 26.
    Magrina, JF 2002Complications of laparoscopic surgery.Clin Obstet Gynecol45469480CrossRefPubMedGoogle Scholar
  27. 27.
    Marana, R, Luciano, AA, Muzii, L, Marendino, VE, Mancuso, S 1994Laparoscopy versus laparotomy for ovarian conservative surgery: a randomized trial in the rabbit model.Am J Obstet Gynecol171861864PubMedGoogle Scholar
  28. 28.
    Menzies, D, Ellis, H 1990Intestinal obstruction from adhesions—how big is the problem?Ann R Coll Surg Engl726063PubMedGoogle Scholar
  29. 29.
    Milingos, S, Kallipolitis, G, Loutradis, D, Liapi, A, Mavrommatis, K, Drakakis, P, Tourikis, J, Creatsas, G, Michalas, S 2000Adhesions: laparoscopic surgery versus laparotomy.Ann N Y Acad Sci900272285PubMedGoogle Scholar
  30. 30.
    Mohamed, AY, al-Ghaithi, A, Langevin, JM, Nassar, AH 1997Causes and management of intestinal obstruction in a Saudi Arabian hospital.J R Coll Surg Edinb422123PubMedGoogle Scholar
  31. 31.
    Moore, RG, Partin, AW, Adams, JB, Kavoussi, LR 1995Adhesion formation after transperitoneal nephrectomy: laparoscopic vs open approach.J Endourol9277280PubMedGoogle Scholar
  32. 32.
    No authors, listed 1994Improvement of interobserver reproducibility of adhesion scoring systems. Adhesion Scoring Group.Fertil Steril62984988PubMedGoogle Scholar
  33. 33.
    Jacobi, CA, Sterzel, A, Braumann, C, Halle, E, Stosslein, R, Krähenbühl, L, Muller, JM 2001The impact of conventional and laparoscopic colon resection (CO2 or helium) on intraperitoneal adhesion formation in a rat peritonitis model.Surg Endosc15380386PubMedGoogle Scholar
  34. 34.
    Pestieau, SR, Marchettini, P, Stuart, OA, Chang, D, Sugarbaker, PH 2002Prevention of intraperitoneal adhesions by intraperitoneal lavage and intraperitoneal 5-fluorouracil: experimental studies.Int Surg87195200PubMedGoogle Scholar
  35. 35.
    Polymeneas, G, Theodosopoulos, T, Stamatiadis, A, Kourias, E 2001A comparative study of postoperative adhesion formation after laparoscopic vs open cholecystectomy.Surg Endosc154143PubMedGoogle Scholar
  36. 36.
    Raftery, AT 1981Effect of peritoneal trauma on peritoneal fibrinolytic activity and intraperitoneal adhesion formation. An experimental study in the rat.Eur Surg Res13397401PubMedGoogle Scholar
  37. 37.
    Schippers, E, Tittel, A, Ottinger, A, Schumpelick, V 1998Laparoscopy versus laparotomy: comparison of adhesion-formation after bowel resection in a canine model.Dig Surg15145147CrossRefPubMedGoogle Scholar
  38. 38.
    Suematsu, T, Hirabayashi, Y, Shiraishi, N, Adachi, Y, Kitamura, H, Kitano, S 2001Morphology of the murine peritoneum after pneumoperitoneum vs laparotomy.Surg Endosc15954958CrossRefPubMedGoogle Scholar
  39. 39.
    Swank, DJ, Swank-Bordewijk, SC, Hop, WC, Erp, WF, Janssen, IM, Bonjer, HJ, Jeekel, J 2003Laparoscopic adhesiolysis in patients with chronic abdominal pain: a blinded randomised controlled multi-centre trial.Lancet36112471251CrossRefPubMedGoogle Scholar
  40. 40.
    Swank, DJ, Erp, WF, Repelaer Driel, OJ, Hop, WC, Bonjer, HJ, Jeekel, H 2003A prospective analysis of predictive factors on the results of laparoscopic adhesiolysis in patients with chronic abdominal pain.Surg Laparosc Endosc Percutan Tech138894CrossRefPubMedGoogle Scholar
  41. 41.
    Tamijmarane, A, Chandra, S, Smile, SR 2000Clinical aspects of adhesive intestinal obstruction.Trop Gastroenterol21141143PubMedGoogle Scholar
  42. 42.
    Tittel, A, Treutner, KH, Titkova, S, Ottinger, A, Schumpelick, V 2001Comparison of adhesion reformation after laparoscopic and conventional adhesiolysis in an animal model.Langenbecks Arch Surg386141145CrossRefPubMedGoogle Scholar
  43. 43.
    Krabben, AA, Dijkstra, FR, Nieuwenhuijzen, M, Reijnen, MM, Schaapveld, M, Goor, H 2000Morbidity and mortality of inadvertent enterotomy during adhesiotomy.Br J Surg87467471CrossRefPubMedGoogle Scholar
  44. 44.
    Volz, J, Koster, S, Spacek, Z, Paweletz, N 1999Characteristic alterations of the peritoneum after carbon dioxide pneumoperitoneum.Surg Endosc13611614CrossRefPubMedGoogle Scholar
  45. 45.
    Vrijland, WW, Jeekel, J, Geldorp, HJ, Swank, DJ, Bonjer, HJ 2003Abdominal adhesions: intestinal obstruction, pain, and infertility.Surg Endosc14.Google Scholar
  46. 46.
    Wysocki, A, Krzywon, J 2001Causes of intestinal obstruction.Przegl Lek58507508PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • C. N. Gutt
    • 1
  • T. Oniu
    • 1
  • P. Schemmer
    • 1
  • A. Mehrabi
    • 1
  • M. W. Büchler
    • 1
  1. 1.Department of General, Visceral- and Trauma SurgeryRuprecht Karls-UniversityHeidelbergGermany

Personalised recommendations