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 .
Chance of adhesion formation after laparoscopic salpingo-ovariolysis: is there a place for second-look laparoscopy?
STUDY OBJECTIVE To evaluate the chance of adhesion formation after  laparoscopic salpingo-ovariolysis  and determine the efficacy of early second-look laparoscopy ( SLL ) . DESIGN Prospect i ve , r and omized study ( Canadian Task Force classification I ) . SETTING Shiraz University hospitals . SUBJECT Ninety women with mean duration of infertility of 7.2 years . INTERVENTIONS Operative laparoscopy , with early SLL with adhesiolysis in 46 ( group 1 ) and no SLL in 44 women ( group 2 ) . MEASUREMENTS AND MAIN RESULTS Adnexal adhesions were evaluated according to American Society for Reproductive Medicine adhesion classification . Separation of newly reformed adhesions was performed at the time of SLL . Patients were followed for a year after operation without other infertility treatment . At the time of operation in group 1 , adnexal adhesions were grade d as severe ( class D ) in 19 women , moderate ( class C ) in 31 , mild ( class B ) in 28 , and minimal ( class A ) in 14 . Respective figures in group 2 were 10 , 30 , 34 , and 14 . After salpingo-ovariolysis these figures were 12 , 10 , 20 , and 50 in group 1 and 6 , 14 , 17 , and 51 in group 2 . In group 1 in whom early second-look laparoscopy was performed , at the start of the operation these figures were 17 , 20 , 21 , and 34 , and after operation 12 , 8 , 20 , and 52 , respectively . There were 11 term pregnancies in group 1 and 15 in group 2 . No women with severe adhesions in either group conceived . In group 1 , chances of term pregnancy were 18.75 % for those with moderate adhesions , 35.71 % for women with mild adhesions , and 42.86 % in patients with minimal adhesions . Respective figures in group 2 were 26.67 % , 41.18 % , and 57.14 % . CONCLUSION The chance of moderate and severe adhesion reformation after laparoscopic salpingo-ovariolysis was 40.2 % . Although separation of these adhesions could be performed more easily at the time of early SLL , the chance of pregnancy did not increase compared with that in patients who did not undergo SLL
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 .