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 .
Laparoscopic salpingotomy for tubal pregnancy: comparison of linear salpingotomy with and without suturing.
BACKGROUND The study was carried out to clarify the incidence of post-operative tubal adhesions , patency rate and pregnancy outcome after laparoscopic salpingotomy with and without suturing for tubal pregnancy . METHODS From May 1996 to December 2002 , a total of 97 cases of tubal pregnancy were treated in our centre by laparoscopic conservative surgery . The successful salpingotomy cases were r and omly assigned to undergo salpingotomy without suturing ( group I ; n = 43 ) or with suturing ( group II ; n = 32 ) . We compared these patients and assessed their surgical and pregnancy outcome by second look laparoscopy ( SLL ) 3 months after the first operation . RESULTS Seventy-five cases ( 77 % ) were treated successfully by salpingotomy at initial laparoscopic surgery , and the remaining 22 cases were unsuccessful because of bleeding or complete tubal damage . Pelvic findings were assessed at SLL in 21 of 43 cases ( 49 % ) in group I and 17 of 32 ( 53 % ) in group II . There were no significant differences in gestational age , ectopic site , tubal diameter , tubal condition , intraperitoneal haemorrhage and pre-operative HCG levels between the two groups . Only the operation time was longer in group II than in group I ( 91 + /- 15 versus 69 + /- 15 min , P < 0.05 ) . The tubal patency rate of the treated side was 90 % ( 19/21 ) in group I and 94 % ( 16/17 ) in group II . Also the peritubal adhesions were observed in 33 % ( 7/21 ) in group I and 29 % ( 5/17 ) in group II , and were mostly comprised of filmy adhesions . A tubal fistula occurred in two cases in each group . Pregnancy rate was 79 % ( 15/19 ) in group I and 92 % ( 12/13 ) in group II , and this did not reveal any significant difference of cumulative pregnancy rate between the groups . CONCLUSION We recommend laparoscopic linear salpingotomy as a useful method in the management of cases with tubal pregnancy who desire future pregnancy . This preliminary study emphasizes that the procedure involving suturing has no additional benefit over the non-suturing technique during salpingotomy
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 .