Fewer adhesions after laparoscopic surgery?

Abstract

In their review article, Gutt et al. [2] assess the incidence of adhesions after laparoscopic and laparotomic surgery. Although the available data favor laparoscopic surgery, the authors state that ‘‘an evidence-based statement could not emerge from this review,’’ mainly because only a handful of clinicals studies were identified and included in their review. Furthermore, the clinical studies obviously did not include a randomized comparison between the laparoscopic and open approach. Although we completely agree with the authors summary that laparoscopic surgery produces fewer adhesions, we think that the available clinical evidence allows us to come to a much stronger conclusion. In fact, one important trial has escaped the authors notice. De Wilde [1] described a randomized controlled trial of 40 women with appendicitis and endometriosis who underwent appendectomy either by a classical or by a laparoscopic approach. Three months after appendectomy, all women had diagnostic or therapeutic laparoscopy for their endometriosis. Adhesions between bowel, omentum, and abdominal wall were seen significantly less frequently in the laparoscopic (two of 20) than in the open group (16 of 20), but the exact localization and extent of the adhesions were not described because the study has never been reported as complete paper. We believe that the results of this study, together with the evidence reported by Gutt et al. [1], justify an even more optimistic statement on the role of laparoscopic surgery in preventing postoperative adhesions. Still, long-term studies are needed for many procedures [3].