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 .
Effects of visceral peritoneal closure on scar formation at cesarean delivery.
OBJECTIVE To determine the effect of closure or non-closure of the visceral peritoneum at cesarean delivery on uterine scar formation assessed at repeat cesarean delivery . METHODS Women undergoing initial cesarean delivery were allocated into 2 groups : group 1 underwent visceral peritoneal closure , while in group 2 the visceral peritoneum was not closed . At repeat cesarean delivery 4 specimens from the initial uterine scar were collected and assessed by light microscopy and scanning electron microscopy . RESULTS In group 1 , 57 % of women had adhesions compared with 20.6 % in group 2 ( P<0.05 ) . Light microscopy revealed reactive mesothelial hyperplasia ( 51.8 % vs 13.7 % ) , submesothelial fibrosis ( 48.1 % vs 6.8 % ) , and neoangiogenesis of mesothelial stroma ( 44.4 % vs 12 % ) in group 1 and group 2 patients , respectively ( P<0.05 ) . Scanning electron microscopy showed more patients with pericytes on the surface of microvessels in group 1 compared with group 2 ( 26.3+/-1.4 vs 11.5+/-1.1 patients ; P<0.05 ) . CONCLUSION Closure of the visceral peritoneum at cesarean delivery may produce an inflammatory reaction and adhesions , evidence d by reactive and regenerative mesothelial hyperplasia and submesothelial fibrosis
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 .