title: Multicenter Observational Study of Adhesion Formation After Open-and Laparoscopic Surgery for Colorectal Cancer.
abstract: The aim of this study was to compare adhesion formation after laparoscopic and open colorectal cancer resection.
  
  
  
  After colorectal surgery, most patients develop adhesions, with a high burden of complications. Laparoscopy seems to reduce adhesion formation, but evidence is poor. Trials comparing open- and laparoscopic colorectal surgery have never assessed adhesion formation.
  
  
  
  Data on adhesions were gathered during resection of colorectal liver metastases. Incidence of adhesions adjacent to the original incision was compared between patients with previous laparoscopic- and open colorectal resection. Secondary outcomes were incidence of any adhesions, extent and severity of adhesions, and morbidity related to adhesions or adhesiolysis.
  
  
  
  Between March 2013 and December 2015, 151 patients were included. Ninety patients (59.6%) underwent open colorectal resection and 61 patients (40.4%) received laparoscopic colorectal resection. Adhesions to the incision were present in 78.9% after open and 37.7% after laparoscopic resection (P < 0.001). The incidence of abdominal wall adhesions and of any adhesion was significantly higher after open resection; the incidence of visceral adhesions did not significantly differ. The extent of abdominal wall and visceral adhesions and the median highest Zühlke score at the incision were significantly higher after open resection. There were no differences in incidence of small bowel obstruction during the interval between the colorectal and liver operations, the incidence of serious adverse events, and length of stay after liver surgery.
  
  
  
  Laparoscopic colorectal cancer resection is associated with a lower incidence, extent, and severity of adhesions to parietal surfaces. Laparoscopy does not reduce the incidence of visceral adhesions.
authors.affiliation: Department of Surgery, Radboud university medical center, Nijmegen, The Netherlands.
authors.forename: Martijn W J
authors.initials: MWJ
authors.lastname: Stommel
authors.affiliation: Department of Surgery, Radboud university medical center, Nijmegen, The Netherlands.
authors.forename: Richard P G
authors.initials: RPG
authors.lastname: Ten Broek
authors.affiliation: Department of Surgery, Radboud university medical center, Nijmegen, The Netherlands.
authors.forename: Chema
authors.initials: C
authors.lastname: Strik
authors.affiliation: Department of Surgery, Maxima Medical Center, Veldhoven, The Netherlands.
authors.forename: Gerrit D
authors.initials: GD
authors.lastname: Slooter
authors.affiliation: Department of Surgery, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands.
authors.forename: Cornelis
authors.initials: C
authors.lastname: Verhoef
authors.affiliation: Department of Surgery, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Grünhagen
authors.affiliation: Department of Surgery, Gelre Hospital, Apeldoorn, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: van Duijvendijk
authors.affiliation: Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Marc H A
authors.initials: MHA
authors.lastname: Bemelmans
authors.affiliation: Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Marcel
authors.initials: M
authors.lastname: den Dulk
authors.affiliation: Department of Surgery, Gelderse Vallei Hospital, Ede, The Netherlands.
authors.forename: Colin
authors.initials: C
authors.lastname: Sietses
authors.affiliation: Department of Surgery, Gelderse Vallei Hospital, Ede, The Netherlands.
authors.forename: Tjarda N T
authors.initials: TNT
authors.lastname: van Heek
authors.affiliation: Department of Surgery, Radboud university medical center, Nijmegen, The Netherlands.
authors.forename: Peter B
authors.initials: PB
authors.lastname: van den Boezem
authors.affiliation: Department of Surgery, Radboud university medical center, Nijmegen, The Netherlands.
authors.forename: Johannes H W
authors.initials: JHW
authors.lastname: de Wilt
authors.affiliation: Department of Surgery, Radboud university medical center, Nijmegen, The Netherlands.
authors.forename: Harry
authors.initials: H
authors.lastname: van Goor
mesh_terms: D034861:Abdominal Wall / Q000473:pathology; D000368:Aged; D003082:Colectomy / Q000009:adverse effects*; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology; D007421:Intestine, Small / Q000473:pathology; D010535:Laparoscopy / Q000009:adverse effects*; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D000267:Tissue Adhesions / Q000209:etiology* / Q000601:surgery; D014781:Viscera / Q000473:pathology