None of the techniques that were compared significantly reduced the incidence of adhesive small bowel obstruction .
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 little evidence for the surgical principle that using less invasive techniques , introducing less foreign bodies or causing less ischaemia reduces the extent and severity of adhesions
INTRODUCTION Adhesion formation is the most common complication following  peritoneal surgery  and the leading cause of small bowel obstruction , acquired infertility and inadvertent organ injury at reoperation .
Using a ' good surgical technique ' is advocated as a first step in preventing adhesions .
However , the evidence for different surgical techniques to reduce adhesion formation needs confirmation .
Anterior abdominal wall adhesions after laparotomy or laparoscopy.
STUDY OBJECTIVE To determine the frequency of postoperative adhesions to the anterior abdominal wall peritoneum that could affect safe placement of the initial laparoscopic umbilical cannula at subsequent procedures . DESIGN Prospect i ve cohort study . SETTING Reproductive endocrinology and infertility service of a tertiary care referral hospital . PATIENTS Two hundred fifteen women , 124 with prior abdominal surgery and 91 with no prior surgery . INTERVENTIONS Surgical histories were review ed , abdominal skin scars noted , and extent of anterior abdominal wall adhesions prospect ively recorded . Statistical analysis was performed with the chi2 test . MEASUREMENTS AND MAIN RESULTS No anterior abdominal wall adhesions were present in 91 patients with no previous surgery  or 45 patients with previous laparoscopy  ( 12 had more than 1 laparoscopy ; p < 0.001 vs laparotomy ) . Seventeen ( 59 % ) of 29 patients with a midline vertical incision had anterior wall adhesions ( p < 0.05 vs suprapubic transverse incision ) . Eleven ( 28 % ) of 39 with a suprapubic transverse incision had anterior wall adhesions ( p < 0.001 vs no surgery or laparoscopy ) . Ninety-six percent of adhesions involved omentum and 29 % included bowel . CONCLUSION Prior laparotomy , whether through a midline vertical or suprapubic transverse incision , significantly increased the frequency of anterior abdominal wall adhesions , and these adhesions may complicate the placement of the laparoscopic cannula through the umbilicus
None of the techniques that were compared significantly reduced the incidence of adhesive small bowel obstruction .
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 little evidence for the surgical principle that using less invasive techniques , introducing less foreign bodies or causing less ischaemia reduces the extent and severity of adhesions
INTRODUCTION Adhesion formation is the most common complication following  peritoneal surgery  and the leading cause of small bowel obstruction , acquired infertility and inadvertent organ injury at reoperation .
Using a ' good surgical technique ' is advocated as a first step in preventing adhesions .
However , the evidence for different surgical techniques to reduce adhesion formation needs confirmation .