Within the limitations of the study, the rate of adhesion development appears to be highest for reformed adhesions, lower for de novo 1b adhesions, and lowest for de novo 1a adhesions. Adhesions developed slightly more frequently in laparoscopy than in laparotomy for both de novo 1b and reformed adhesions. This might be a reflection of a reduced ability to achieve hemostasis, to handle tissues atraumatically at direct sites of surgery, or to other factors such as wind chill and desiccation. Crystalloid solution instillates did not appear reduce adhesion development and their use does not seem to be warranted. The objective of the authors' project was to document rates of adhesion development after abdominopelvic surgery with and without crystalloid solution instillates. A meta-analysis of clinical reports (from a MEDLINE search 1/1/1966 to 12/18/1996) involving patients undergoing abdominopelvic surgery was performed. Data from reports meeting inclusion criteria were stratified by adhesion type, access method, and use of intraperitoneal crystalloid solution instillates. Adhesion-free outcome (sites) was lowest for reformed (26.3% laparotomy; 14.3% laparoscopy), higher for de novo 1b (direct trauma) adhesions (45.2% laparotomy; 37.2% laparoscopy), and highest for de novo 1a (indirect trauma) adhesions (82.4% laparoscopy). Crystalloid solution instillates reduced adhesion-free outcome at sites (45.2% versus 20% de novo 1b adhesions in laparotomy) and in patients (43.5% versus 19.9% reformed, laparotomy; 71.7% versus 25%, de novo 1b, laparoscopy). Adhesion-free outcome was lowest for reformed, higher for de novo 1b, and highest for de novo 1a adhesions. It was lower in laparoscopy than in laparotomy for de novo 1b and reformed adhesions. Crystalloid instillates did not increase adhesion-free outcome. While limited by the retrospective and heterogeneous nature of the data, these conclusions nonetheless provide a basis on which to formulate future hypotheses.
|Original language||English (US)|
|Number of pages||9|
|Journal||Infertility and Reproductive Medicine Clinics of North America|
|State||Published - Jul 2003|
ASJC Scopus subject areas
- Obstetrics and Gynecology