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 laparoscopic surgery in tubal pregnancy: a randomized trial versus laparotomy.
OBJECTIVE Women with ectopic pregnancy ( EP ) who have been operated on by laparoscopy  are thought to have improved subsequent fertility , probably because of less adhesion formation . We aim ed to evaluate the adhesion formation after laparoscopy as compared with laparotomy in a r and omized trial . DESIGN One hundred five patients with tubal pregnancy were stratified with regard to age and risk factors and r and omized to surgery by laparoscopy or laparotomy . To evaluate adhesion formation and tubal status , 73 patients with strong desire of pregnancy underwent a second-look laparoscopy . The adhesion status at the ipsilateral and contralateral side at primary surgery was compared with the status at second-look laparoscopy . RESULTS Patients operated on by laparotomy developed significantly more adhesions at the operated side than patients operated on by laparoscopy ( P less than 0.001 ) . Substantially more patients in the laparotomy group underwent adhesiolysis at second-look laparoscopy than did patients in the laparoscopy group . Tubal patency did not differ between the groups . CONCLUSIONS Laparoscopic treatment of EP results in less impairment of the pelvic status compared with conventional conservative surgery
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 .