The rates of adhesion development and the effects of crystalloid solutions on adhesion development in pelvic surgery.
OBJECTIVE
To document rates of adhesion development after abdomino-pelvic surgery, stratified by adhesion type, access method, and use of crystalloid solution instillates.


METHODS
Reports from a MEDLINE search (1/1/1966-12/18/1996) detailing rates of adhesion development and meeting the inclusion criteria were subjected to meta-analysis.


METHODS
Meta-analysis.


METHODS
Patients undergoing abdomino-pelvic surgery.


METHODS
Intraperitoneal crystalloid solution instillates.


METHODS
Percentage adhesion-free outcome in patients ("patients") or surgical sites ("sites").


RESULTS
Adhesion-free outcome (sites) was lowest for reformed (26.3% laparotomy; 14.3% laparoscopy), higher for de novo 1b (direct trauma) (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).


CONCLUSIONS
Adhesion-free outcome was lowest for reformed, higher for de novo 1b, and highest for de novo 1a adhesions. Surprisingly, it was lower in laparoscopy than in laparotomy for de novo 1b and reformed adhesions. Crystalloid instillates did not increase adhesion-free outcome. Although limited by the retrospective and heterogeneous nature of the data, these conclusions nonetheless provide a basis on which to formulate future hypotheses.
Wiseman
D M
DM
SYNECHION, Inc., Dallas, Texas 75248, USA. SYNECHION@AOL.COM
Trout
J R
JR
Diamond
M P
MP
D003460:Crystallization; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D015994:Incidence; D007552:Isotonic Solutions; D010535:Laparoscopy; D007813:Laparotomy; D010388:Pelvis / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D000077331:Ringer's Solution; D000267:Tissue Adhesions / Q000453:epidemiology / Q000517:prevention & control
D007552:Isotonic Solutions; D000077331:Ringer's Solution