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 .
Does the peritoneum need to be closed at laparotomy?
Closure of vertical laparotomy wounds was r and omized between a two‐layer technique of continuous catgut to peritoneum and continuous nylon to sheath and a one‐layer technique in which the peritoneal suture line was omitted . In 162 two‐layer closures there were 4 burst abdomens and 7 wound hernias ( 6·8 per cent wound failures ) ; in 164 one‐layer closures there were 5 burst abdomens and 7 hernias ( 7·3 per cent failures ) . Of 21 patients in this series with jaundice  , the abdominal wounds dehisced in 3 , and 4 patients developed incisional hernias ( 33·3 per cent failures ) compared with a 5·2 per cent failure rate in the 305 non‐jaundiced patients ( P < 0·01 )
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 .