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 .
Reduction of adhesions after uterine myomectomy by Seprafilm membrane (HAL-F): a blinded, prospective, randomized, multicenter clinical study. Seprafilm Adhesion Study Group.
OBJECTIVE To assess the safety and efficacy of Seprafilm ( HAL-F ) , Bioresorbable Membrane , ( Genzyme Corporation , Cambridge , MA ) in reducing the incidence , severity , extent , and area of uterine adhesions after myomectomy . DESIGN Prospect i ve , r and omized , blinded , multicenter study . Adhesion reduction was assessed by an independent , blinded , gynecologic surgeon who review ed videotapes of each patient 's second-look laparoscopy . SETTING Nineteen institutions across the United States . PATIENT(S ) One hundred twenty-seven women undergoing uterine myomectomy with at least one posterior uterine incision > or = 1 cm in length . INTERVENTION(S ) Patients were r and omized to treatment with Seprafilm or to no treatment at the completion of the myomectomy . MAIN OUTCOME MEASURE(S ) The incidence , severity , extent , and area of uterine adhesions at second-look laparoscopy . RESULT ( S ) The incidence , measured as the mean number of sites adherent to the uterine surface , was significantly less in treated patients ( 4.98 + /- 0.52 [ mean + /- SEM ] sites ) than in no treatment patients ( 7.88 + /- 0.48 sites ) as were the mean uterine adhesion severity scores ( 1.94 + /- 0.14 versus 2.43 + /- 0.10 ; treatment versus no treatment , respectively ) , mean extent scores ( 1.23 + /- 0.12 versus 1.68 + /- 0.10 ) , and mean area of adhesions ( 13.2 + /- 1.67 versus 18.7 + /- 1.66 cm2 ) . No adverse events occurred that were judged to be related to the use of Seprafilm . CONCLUSION ( S ) In this multicenter study , treatment of patients after myomectomy with Seprafilm significantly reduced the incidence , severity , extent , and area of postoperative uterine adhesions . Additionally , Seprafilm treatment was not associated with an increase in postoperative complications
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 .