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

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

Metformin versus clomiphene citrate for infertility in non-obese women with polycystic ovary syndrome: a systematic review and meta-analysis.

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

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Ten Broek, R. P. G. Kok-Krant, N. Bakkum, E. A. Bleichrodt, R. P. Van Goor, H.
Description	Country affiliation: Netherlands Author Affiliation: Ten Broek RP ( Department of Surgery, Radboud University Nijmegen Medical Centre, HB Nijmegen, The Netherlands.)
Abstract	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. METHODS 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. RESULTS 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): 0.03-0.61] and when the peritoneum was not closed (RR 0.36; 95% CI: 0.21-0.63). CONCLUSIONS 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.
File Format	HTM / HTML
ISSN	13554786
e-ISSN	14602369
Journal	Human Reproduction Update
Issue Number	1
Volume Number	19
Language	English
Publisher	Oxford University Press
Publisher Date	2013-01-01
Publisher Place	Great Britain (UK)
Access Restriction	Open
Subject Keyword	Discipline Embryology Discipline Reproductive Medicine Peritoneum Surgery Postoperative Complications Prevention & Control Surgical Procedures, Operative Adverse Effects Tissue Adhesions Intestinal Obstruction Etiology Laparoscopy Postoperative Period Randomized Controlled Trials As Topic Reoperation Utilization Second-look Surgery Complications Comparative Study Meta-analysis
Content Type	Text
Resource Type	Article
Subject	Reproductive Medicine Obstetrics and Gynecology

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