title: Intra-abdominal adhesion formation: does surgical approach matter? Questionnaire survey of South Asian surgeons and literature review.
abstract: OBJECTIVE
  The impact of postsurgical intra-abdominal adhesions, which represent a considerable burden for patients and health services, is often underestimated. Various factors influence adhesion formation, including the surgical approach. This study aimed to further understand the condition by investigating surgeons' perceptions of adhesion formation, particularly differences after laparoscopic and open surgery, and by performing a selective literature review.
  
  
  METHODS
  South Asian surgeons attending endoscopy symposia in India and in Germany completed Likert-scale-based questionnaires on awareness of adhesion formation and associated consequences in gynecology. MEDLINE and PubMed were searched for articles published in 2000-2010 comparing laparoscopy and laparotomy in relation to adhesion formation. The results of the questionnaire study were then considered in view of findings from this review.
  
  
  RESULTS
  In total, 43.1% (97/225) of questionnaires were completed. Respondents considered that laparoscopy caused fewer adhesions than laparotomy for all gynecological procedures. Although they believed their knowledge of adhesion formation was satisfactory, they widely underestimated the risk, giving estimated rates of 12.5% after laparoscopy and 36.3% after laparotomy. Twenty-eight studies were identified in the review. Most concluded that laparoscopy was less likely to cause adhesions than laparotomy but further statistical analysis was precluded because so many different definitions and classifications of adhesions had been used.
  
  
  CONCLUSIONS
  The risk of adhesion formation was widely underestimated in the study group. Both the questionnaire study and the review concluded that laparoscopy results in less adhesion than laparotomy but further statistical comparison necessitates the development of standard definitions and classifications of adhesions.
authors: Department of Obstetrics and Gynaecology, Justus-Liebig-University of Giessen, Giessen, Germany. andreas.hackethal@gyn.med.uni-giessen.de
authors: Andreas
authors: A
authors: Hackethal
authors: Claudia
authors: C
authors: Sick
authors: Gabor
authors: G
authors: Szalay
authors: Shailesh
authors: S
authors: Puntambekar
authors: Kurian
authors: K
authors: Joseph
authors: Swapnil
authors: S
authors: Langde
authors: Frank
authors: F
authors: Oehmke
authors: Hans-Rudolf
authors: HR
authors: Tinneberg
authors: Karsten
authors: K
authors: Muenstedt