A Systematic Review and Meta-Analysis for Surgical Techniques Intended to Alleviate Post-Operative Adhesions Following Abdominal and Pelvic Surgery

Abstract

Background: postoperative peritoneal adhesions are common and frequent complication following abdominal and Pelvic Surgery. Adhesions can lead to bowel obstructions and infertility in women (when they develop around the reproductive organs), chronic pain which consequently results in reducing the quality of life for patients, level of energy, productivity, and increase the risk, complexity and chance of complications in subsequent surgeries .Main objective of this review is to study the implication of using the ‗good surgical techniques' in the prevention of postoperative adhesions. Methods: the present review included randomized controlled trials (RCTs) that investigated the different surgical technique impact on adhesion-related outcomes were identified through search in Pubmed, CENTRAL and Embase. Identified endpoints were: clinical outcomes and incidence of adhesions. The primary Identification of papers and data extraction were performed by independent researchers. Results: out of 1709 studies, there were only 21 papers eligible for a systematic review and included in the meta-analysis and qualitative assessment. None of the techniques that were compared significantly reduced the incidence of adhesive small bowel obstruction. In a small low-quality trial, the pregnancy rate increased after subserous fixation of suture knots. However, the incidence of adhesions was lower after laparoscopic compared with open surgery [relative risk (RR) 0.14; 95% confidence interval (CI): 0.03-0.61] and when the peritoneum was not closed (RR 0.36; 95% CI: 0.21-0.63). Conclusion: None of the specific techniques that were compared reduced the two main adhesion-related clinical outcomes, small bowel obstruction and infertility. The meta-analysis provides some evidence for the surgical principle that using less invasive techniques, introducing less foreign bodies or causing less ischemia reduces the extent and severity of adhesions.