Reduced adhesion formation following laparoscopic versus open colorectal surgery.
BACKGROUND
Adhesion formation is common after abdominal surgery. This study aimed to compare the extent of adhesion formation following laparoscopic and open colorectal surgery.


METHODS
An observational study was undertaken to identify adhesions in patients undergoing laparoscopy after previous laparoscopic or open colectomy. Adhesions were scored according to a system validated for interobserver (median kappa = 0.80) and intraobserver (kappa = 0.82) agreement. The primary endpoint was the overall adhesion score (0-10); a secondary endpoint was the adhesion score at the main incision site (0-6).


RESULTS
Forty-six patients were recruited (13 laparoscopic and 33 open colectomy). In most patients (n = 29), laparoscopy was performed for tumour staging before liver resection. The median (interquartile range) overall adhesion score was 7 (5-8) in the open group and 0 (0-3) in the laparoscopic group (P < 0.001). A similar difference was found for the main incision score: 6 (4-6) versus 0 (0-0) (P < 0.001).


CONCLUSIONS
There may be a reduction in adhesion formation following laparoscopic compared with open colectomy, although the small sample size limits this conclusion.
Minimal Access Therapy Training Unit, University of Surrey, Guildford, UK. hdowson@doctors.org.uk
H M
HM
Dowson
J J
JJ
Bong
D P
DP
Lovell
T R
TR
Worthington
N D
ND
Karanjia
T A
TA
Rockall
D000328:Adult; D000368:Aged; D003082:Colectomy / Q000379:methods; D015179:Colorectal Neoplasms / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D015588:Observer Variation; D012086:Reoperation; D000267:Tissue Adhesions / Q000517:prevention & control*; D016896:Treatment Outcome