title: Minimal-access colorectal surgery is associated with fewer adhesion-related admissions than open surgery.
abstract: BACKGROUND
  This study aimed to describe national intermediate-term admission rates for incisional hernia or clinically apparent adhesions following colorectal surgery, and to compare rates following laparoscopic and open approaches.
  
  
  METHODS
  Patients undergoing primary colorectal resection between 2002 and 2008 were included from the Hospital Episode Statistics database. Subsequent inpatient admissions were extracted for up to 3 years after the initial operation or to the end of the study period. Outcomes examined were admissions with a diagnosis of, or operative interventions for, incisional hernia or adhesions.
  
  
  RESULTS
  A total of 187 148 patients were included between 2002 and 2008, with median follow-up of 31·8 (interquartile range 13·1-35·3) months. Some 8885 (4·7 per cent) of these patients were admitted with a diagnosis of, or underwent a repair of, an incisional hernia. In multiple regression analysis, use of laparoscopy was not a predictor of operative intervention for incisional hernia (odds ratio 1·09, 95 per cent confidence interval (c.i.) 0·99 to 1·21; P = 0·083). Some 15 125 (8·1 per cent) of the patients were admitted with a diagnosis of adhesions or had a procedure for division of adhesions. Overall, 3·5 per cent (6637 of 187 148) of patients underwent adhesiolysis. Patients selected for a laparoscopic procedure had lower rates of admission for adhesions (6·3 per cent (692 of 11 013) for laparoscopic versus 8·2 per cent (14 433 of 176 135) for open surgery; P < 0·001) and reintervention for adhesions (2·8 per cent (305 of 11 013) versus 3·6 per cent (6325 of 176 135) respectively; P < 0·001) than those undergoing an open procedure. In multiple regression analysis, patients selected for a laparoscopic procedure had lower subsequent intervention rates for adhesions (odds ratio 0·80, 95 per cent c.i. 0·71 to 0·90; P < 0·001).
  
  
  CONCLUSIONS
  Patients undergoing colorectal resection who are selected for the laparoscopic approach have a lower risk of developing clinically significant adhesions.
authors.affiliation: Department of Surgery, Imperial College, St Mary's Hospital, London, UK.
authors.forename: E M
authors.initials: EM
authors.lastname: Burns
authors.forename: A
authors.initials: A
authors.lastname: Currie
authors.forename: A
authors.initials: A
authors.lastname: Bottle
authors.forename: P
authors.initials: P
authors.lastname: Aylin
authors.forename: A
authors.initials: A
authors.lastname: Darzi
authors.forename: O
authors.initials: O
authors.lastname: Faiz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D003107:Colorectal Surgery / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006547:Hernia / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data*; D012086:Reoperation; D000267:Tissue Adhesions / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D055815:Young Adult