title: Multi-layered intra-abdominal adhesion prophylaxis following laparoscopic colorectal surgery.
abstract: BACKGROUND
  Small bowel obstruction secondary to intra-abdominal adhesions is a frequent postoperative complication. Less invasive surgery carries a lower risk of postoperative adhesions, but adhesions may still occur after laparoscopic colorectal surgery. We present here some of our methods of adhesion prophylaxis for laparoscopic colorectal surgery.
  
  
  METHODS
  The 167 patients who underwent laparoscopic colorectal surgery at our center from 2007 to 2012 were retrospectively reviewed. To prevent postoperative intra-abdominal adhesions, anti-adhesion barriers were placed using the half-overlap method. The rate of postoperative small bowel obstruction was compared among three groups: patients who received no adhesion prophylaxis (Group NP), patients who received single-layered adhesion prophylaxis adjacent to the incision (Group SP), and patients who received three layers of adhesion prophylaxis at different depths (Group MLP).
  
  
  RESULTS
  The rate of postoperative ileus was significantly different among the three groups, at 9.7 % (6/62) in Group NP, 5.0 % (1/19) in Group SP, and 0 % (0/86) in Group MLP).
  
  
  CONCLUSIONS
  This retrospective analysis found that placement of multi-layered anti-adhesion barriers using the half-overlap method provided the most effective prophylaxis. Prospective clinical trials are needed to further evaluate these methods of anti-adhesion prophylaxis.
authors.affiliation: Department of Digestive Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan, atsuatsu@apost.plala.or.jp.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tsuruta
authors.forename: Tadashi
authors.initials: T
authors.lastname: Itoh
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Hirai
authors.forename: Masafumi
authors.initials: M
authors.lastname: Nakamura
mesh_terms: D000328:Adult; D003107:Colorectal Surgery / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D007421:Intestine, Small / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control*
chemical_list: C118198:Seprafilm; D006820:Hyaluronic Acid