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 .
A randomized, controlled pilot study of the safety and efficacy of 4% icodextrin solution in the reduction of adhesions following laparoscopic gynaecological surgery.
BACKGROUND Adhesion-related readmissions are frequent sequelae to gynaecological surgery . Attempts to prevent adhesions by separating healing peritoneal surfaces include site-specific barriers and hydroflotation by instilled solutions . Rapid absorption limits the effectiveness of solutions such as Ringer 's lactated saline ( RLS ) . This pilot study assessed the safety , tolerability and preliminary effectiveness of a non-viscous , iso-osmolar solution of 4 % icodextrin , an alpha-1,4 glucose polymer with prolonged intraperitoneal residence , in reducing adhesions after laparoscopic gynaecological surgery . METHODS Women aged > or = 18 years , requiring laparoscopic adnexal surgery ( n = 62 ) , were entered into a r and omized , open-label , assessor-blinded , multicentre study to compare 4 % icodextrin with RLS . Treatments were coded in blocks of four with equal r and omization to each group , and pre-allocated to consecutively numbered patients . At least 100 ml per 30 min was used for intra-operative lavage , with 1 l instilled post-operatively . Per protocol analysis included all eligible patients ( n = 53 ) ; reformation analysis required one or more baseline adhesion ( n = 42 ) . Incidence , extent and severity of post-operative adhesions were assessed at second-look laparoscopy after 6 - 12 weeks . Procedures were video-taped for third party , blinded assessment . RESULTS Safety and tolerability ( laboratory variables , adverse events , clinical follow-up ) were good with no difference between treatments . A shift analysis of incidence-ranked adhesions ( n = 53 ) showed apparent improvements in more patients with icodextrin than RLS ( 37 versus 15 % ; not significant ) . Adhesion score reduction ( n = 42 ) was more frequent in icodextrin- than RLS-treated patients : incidence ( 52 versus 32 % ) , extent ( 52 versus 47 % ) , and severity ( 65 versus 37 % ) . Despite greater baseline adhesions , median reformation was less after icodextrin ( 24 % ) than RLS ( 60 % ) . The pilot study group sizes were not powered for statistical significance . CONCLUSIONS In this preliminary study , 4 % icodextrin lavage plus instillation was well tolerated and reduced adhesion formation and reformation following laparoscopic gynaecological surgery . A Phase III pivotal study is currently in progress
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 .