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 .
Adhesion formation after microlaparoscopic and laparoscopic ovarian coagulation for polycystic ovary disease.
STUDY OBJECTIVE To compare the effects of microlaparoscopy and decreased CO2 exposure on peritoneal microcirculation and potential adhesion formation  after ovarian surgery with those of conventional operative laparoscopy . DESIGN Prospect i ve , r and omized study ( Canadian Task Force classification I ) . SETTING Teaching hospital . PATIENTS Eighteen women with polycystic ovary disease . INTERVENTIONS Microlaparoscopic or laparoscopic ovarian coagulation of the ovaries . MEASUREMENTS AND MAIN RESULTS Approximately 10 to 12 coagulation points were applied to each ovary . Two to 3 weeks after the initial surgery second-look microlaparoscopy was performed to determine the extent of adhesions in both groups . The frequency of adhesion formation and changes in glutathione peroxidase ( GSH-Px ) , superoxide dismutase ( SOD ) , catalase ( CAT ) , and glutathione ( GSH ) levels were studied in homogenized peritoneal tissues obtained during surgery in each group . RESULTS Clinical profiles were similar between groups . Mean exposure , amount , and pressure of CO2 were significantly less in the microlaparoscopy group ( p < 0.05 ) . The laparoscopy group had significantly more adhesions than the microlaproscopy group ( 24 % vs 48 % , p < 0.05 ) . The GSH-Px , SOD , CAT , and GSH levels were significantly lower in the laparoscopy group ( 0 . 425 micromol , 1.2 ng , 37.55 micromol , and 0.9 nmol vs 0.755 micromol , 2.l ng , 625 micromol , and 2.6 nmol , respectively ) . CONCLUSION Reduced exposure to and amount of CO2 during microlaparoscopy may result in decreased adhesion formation compared with conventional laparoscopy . This effect may possibly be due to lack of or minimal adverse effects on peritoneal microcirculation and cell-protective systems , which are proposed mechanisms for adhesion formation and closely related to peritoneal injury . In addition , microlaparoscopy may be a cost-effective alternative to conventional laparoscopy . ( J Am Assoc Gynecol Laparosc 6(2):159 - 163 , 1999
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 .