Comparison of adhesion reformation after laparoscopic and conventional adhesiolysis in an animal model

This study set out to compare adhesion reformation after conventional and laparoscopic adhesiolysis using two different laparoscopic dissection techniques. In a first operation, 36 rabbits underwent fixation of 6 cm2 of the cecum with the serosa removed to the lateral abdominal wall to induce standardized adhesions. After 4 weeks, adhesiolysis was performed laparoscopically (n = 12) or via laparotomy (n = 12) using sharp and blunt dissection. In a third group (n = 12), laparoscopic adhesiolysis was performed using monopolar electrocautery. Outcome was assessed by incidence, extent, and localization of adhesion reformation. After conventional adhesiolysis, all rabbits developed new adhesions relative to 79% after laparoscopic adhesiolysis. The extent of reformed adhesions (median) was greater after conventional adhesiolysis than laparoscopic adhesiolysis (2725 mm2 vs 230 mm2, P < 0.001). The latter did not differ significantly from laparoscopic adhesiolysis by electrocautery (310 mm2). There were small adhesions to 3 of 72 trocar wounds, but extensive adhesions to 33% of the abdominal incisions were found in the conventional group. In this standardized experimental setting, laparoscopic adhesiolysis is associated with a significantly reduced reformation of adhesions. Different laparoscopic dissection techniques have no significant influence on the extent of adhesion reformation.     

Reduction, regrowth, and de novo formation of abdominal adhesions after laparoscopic adhesiolysis: a prospective analysis

AIM: A significant reduction of abdominal adhesions at second-look relaparoscopy after adhesiolysis in patients with chronic abdominal pain. METHODS: 368 patients underwent laparoscopic adhesiolysis because of chronic abdominal pain. Regrowth and de novo abdominal adhesions were determined in a qualitative and quantitative way in 24 patients who underwent a second-look re-laparoscopy because of recurrent pain after a mean period of 16 months after the first laparoscopic adhesiolysis. Reduction of incidence, extent, type, and severity of abdominal adhesions between organs and abdominal wall and de novo adhesion formation were determined. RESULTS: Incidence (40 vs. 26), extent, type, and severity of abdominal adhesions between organs and abdominal wall are significantly reduced after laparoscopic adhesiolysis. After adhesiolysis of adhesions between organs themselves, no significant reduction could be demonstrated (incidence 40 vs. 32). De novo adhesions were present in 5 (5/24) patients. CONCLUSION: Laparoscopic adhesiolysis results in a significant reduction of adhesions between organs and abdominal wall, despite the occurrence of de novo adhesions in about 20% of the patients.     

Comparison of adhesion formation to intra-abdominal mesh after laparoscopic adhesiolysis in the New Zealand White rabbit

The purpose of this study was to investigate the effects of early adhesiolysis on long-term adhesion formation after the intraperitoneal implantation of polypropylene (PP) mesh and expanded polytetrafluoroethylene (ePTFE) mesh in a rabbit model. Through a small midline laparotomy a 2 x 2-cm piece of mesh (n = 80) was sewn to an intact peritoneum on each side of a midline incision in 40 New Zealand White rabbits. Two types of ePTFE mesh [Dual Mesh (Dual) and modified Dual Mesh (C-Type), W.L. Gore and Associates, Flagstaff, AZ] and PP mesh (Marlex, C.R. Bard, Murray Hill, NJ) were compared. In 10 rabbits (n = 20) a laparoscopic adhesiolysis (LapA) was performed at one week. Mesh adhesions were scored using a modified Diamond scale (0, 0%; 1, 1-25%; 2, 26-50%; and 3, > 50%) at 1, 3, 9, and 16 weeks by serial microlaparoscopic (2 mm) examinations. After recording the final adhesion score at 16 weeks the prosthetic biomaterials were excised en bloc with the anterior abdominal wall for histologic evaluation of mesothelial layer growth (%) on the visceral surface of the mesh. Statistical differences (P value < 0.05) were measured by chi-square and Wilcoxon signed rank tests. There were no statistical differences in mean adhesion scores at adhesiolysis at 7 days. The mean adhesion scores in the groups undergoing laparoscopic adhesiolysis was statistically less (P < 0.05) for PP and both ePTFE meshes at 3-, 9-, and 16-week intervals compared with those not undergoing adhesiolysis. The percentage of mesothelialization on the visceral surface of the mesh was not statistically different between the adhesiolysis and control groups for any of the prosthetic biomaterials. Laparoscopic adhesiolysis at one week minimizes subsequent adhesion formation to PP and ePTFE mesh over a 4-month follow-up. Adhesion formation within the first 7 days after mesh implantation appears to determine the long-term adhesion score. Eliminating adhesions to mesh by mechanical or other means during this critical time may control adhesions to the mesh and subsequent mesh-related complications.     

Laparoscopic adhesiolysis

The aim of this study was the detection of criteria that support the indication for laparoscopic adhesiolysis in patients presenting with unspecific symptoms. A prospective analysis investigates the value of laparoscopic adhesiolysis in patients with chronic abdominal pain after exclusion of other pathologic findings; 58 consecutive patients were followed after laparoscopic adhesiolysis. Endpoints of investigation were extent of adhesions, complications, postoperative hospitalization, and postoperative quality of life. A comparison was drawn to patients following laparoscopic cholecystectomy, laparoscopic cholecystectomy plus adhesiolysis, and conventional cholecystectomy.The results showed that major complications occurred in 10% of cases. In 45% of patients we found a complete remission, in 35% a substantial improvement, and in 20% a persistence of complaints. In a correlation between the preoperative complaints and the extent of adhesions we found small adhesions to cause recurrent abdominal pain without other symptoms while large adhesions produce recurrent abdominal pain in combination with symptoms indicative of intermittent bowel obstruction.Finally, the results of this study indicate a certain ideal constellation for an enduring successful adhesiolysis per laparoscopy: it is the subjective complaint of recurrent abdominal pain with a localized and reproducible punctum maximum in combination with a circumscribed area of adhesions at that site.     

Efficacy of a hyaluronan derivative gel in postsurgical adhesion prevention in the presence of inadequate hemostasis.

BACKGROUND: We previously demonstrated that an auto-cross-linked hyaluronan-based antiadhesion agent (auto-cross-linked polysaccharide [ACP] gel) was effective in postsurgical adhesion prevention after open laparotomy and laparoscopic surgery with adequate hemostasis in animal models. This study assessed the ability of different preparations of ACP gel to prevent adhesions in the presence of bleeding or inadequate hemostasis. METHODS: Ninety-seven female rabbits were subjected to a standardized surgical lesion with subsequent exudative abdominal bleeding (oozing model), and 97 animals were subjected to a standardized surgical lesion with severe abdominal bleeding (bleeding model). After injury, the animals were randomly assigned to 5 groups of treatment: 3 different preparations of ACP gel (20, 40, and 60 mg/mL), a hyaluronan-carboxymethylcellulose film, and no treatment. Three weeks after operation, the animals were killed, and the adhesions were assessed by a blinded observer who measured the length and area of the adhesions and who used the Blauer scoring system. RESULTS: All 3 preparations of ACP gel and the hyaluronan-carboxymethylcellulose film reduced adhesion formation in both models (P <.01) as measured by the number of adhesion-free animals, mean Blauer score, and the mean length and surface area of the adhesions. There were no statistical differences between the different treatment groups. CONCLUSIONS: These data suggest that different hyaluronan based agents in the presence of severe bleeding or exudative abdominal bleeding reduce de-novo postsurgical adhesion formation.     

Reduction in postoperative adhesion formation and re-formation after an abdominal operation with the use of N, O - carboxymethyl chitosan

BACKGROUND: Postoperative adhesions have proven to be intractable complications after abdominal operations. This study assessed the efficacy of N, O - carboxymethyl chitosan (NOCC) to limit adhesion formation and re-formation in a rabbit abdominal surgery model. METHODS: In study 1 (adhesion formation), injuries to the large bowel, cecum, and abdominal sidewall were generated in rabbits. The rabbits (10/group) were randomly assigned to 1 of 5 treatment groups: Group A received no NOCC treatment; in group B, NOCC gel was applied directly to the injured site and NOCC solution was applied throughout the abdominal cavity; in group C, NOCC gel was applied near the injured site and NOCC solution was applied as above; in group D, NOCC gel was applied distant to the injury and NOCC solution was applied as above; in group E, a mixture of NOCC gel and solution was applied at the injured site. Adhesions were evaluated 14 days later. In study 2 (adhesion re-formation), adhesions were generated as above but were then lysed by careful dissection. After adhesiolysis, the rabbits (9/group) were treated with NOCC gel and solution at the site of adhesiolysis or left untreated. Adhesion re-formation was assessed 14 days later. In study 3 (mechanism of action), sterile tissue culture plates were coated with NOCC and adhesion of cultured, radiolabeled murine fibroblasts to the plates was assessed. RESULTS: In study 1, animals treated with NOCC gel and solution showed reduced adhesion formation (P<.01). NOCC gel was equally efficacious if applied on the site of injury or near the site of injury but less efficacious if applied at a site distant to the injury. In study 2, animals treated with NOCC gel and solution showed less adhesion re-formation compared with the untreated control animals (P<.01). In study 3, murine fibroblasts did not adhere to NOCC-coated tissue culture plates. CONCLUSIONS: NOCC gel and solution can reduce adhesion formation and re-formation in this rabbit model. The inability of fibroblasts to adhere to NOCC solution-coated surfaces suggests that NOCC may act as a biophysical barrier.     

Intraperitoneal adhesions after open or laparoscopic abdominal procedure: an experimental study in the rat

Abstract Background: Adhesion formation is common after abdominal surgery. The incidence and severity of adhesion formation following open or laparoscopic surgery remain controversial. The role of CO(2) pneumoperitoneum is also widely discussed. This study aimed to compare adhesion formation following peritoneal injury by electrocoagulation performed through open or laparoscopic procedures in a rat model. Materials and Methods: Sixty male rats were randomized to undergo a 1.5-cm peritoneal injury with unipolar cautery under general anesthesia: open surgery (Group A, n=20), laparoscopic surgery with CO(2) pneumoperitoneum (Group B, n=20), and laparoscopic surgery with air pneumoperitoneum (Group C, n=20). Duration of the procedures was fixed at 90 minutes in all groups, and pneumoperitoneum pressure was kept at 10?mm Hg. Ten days later, the animals underwent a secondary laparotomy to score peritoneal adhesions using qualitative and quantitative parameters. Results: Forty-five rats developed at least one adhesion: 95% in Group A, 83% in Group B, and 55% in Group C (P<.01; Group C versus Group A, P<.01). According to number, thickness, tenacity, vascularization, extent, type, and grading according to the Zühkle classification, no significant difference was observed between Groups A and B. The distribution of adhesions after open surgery was significantly different than after laparoscopic surgery (P<.001). It is interesting that Group C rats developed significantly fewer adhesions at the traumatized site, and their adhesions had less severe qualitative scores compared with those after open surgery (P<.01). Conclusions: In this animal model, CO(2) laparoscopic surgery did not decrease the formation of postoperative adhesion, compared with open surgery. The difference with the animals operated on with air pneumoperitoneum emphasizes the role of CO(2) in peritoneal injury leading to adhesion formation.     

Laparoscopic adhesiolysis and placement of Seprafilm: a new technique and novel approach to patients with intractable abdominal pain

Patients who suffer from chronic abdominal pain as a result of postoperative adhesion formation are challenging to treat. Many surgeons argue that operative treatment of these patients exacerbates symptoms because of the continued adhesion formation following each procedure. Seprafilm (Genzyme, Tucker, GA, USA), a bioresorbable membrane of sodium hyaluronate and carboxymethylcellulose, and laparoscopic surgery have both been shown to significantly decrease postoperative adhesion formation. Although the utility of laparoscopy is controversial in the treatment of these patients, the combination of laparoscopy and Seprafilm can provide excellent relief in this difficult patient population. We report a new technique, laparoscopic adhesiolysis and Seprafilm placement, for patients with intractable abdominal pain secondary to adhesions.     

A prospective analysis of predictive factors on the results of laparoscopic adhesiolysis in patients with chronic abdominal pain

Laparoscopic adhesiolysis for chronic abdominal pain is subject for criticism. In this prospective study, we analyze factors that encourage or discourage the indication for therapeutic laparoscopic adhesiolysis. Two hundred twenty-four consecutive patients with chronic abdominal pain underwent diagnostic laparoscopy, and in case of adhesions, they underwent adhesiolysis. Pain relief was assessed, and the individual impact of variables on pain relief was determined. Laparoscopy was performed in 224 patients. Two hundred patients had only adhesions and underwent primary laparoscopic adhesiolysis. Three months after adhesiolysis, 74% of patients were pain-free or had less pain. The remaining 26% of the patients felt no change (22%) or had more pain (4%). Gender, age, and bowel perforation leading to a laparotomy appear to be individual factors significantly influencing pain relief. Laparoscopic adhesiolysis can be done (almost) completely in 92% of patients with adhesions. After laparoscopic adhesiolysis, 74% of patients had good results and 4% had more pain. The complication rate is high.     

Adhesions and adhesiolysis: the role of laparoscopy.

BACKGROUND: Adhesions commonly result from abdominal and pelvic surgical procedures and may result in intestinal obstruction, infertility, chronic pain, or complicate subsequent operations. Laparoscopy produces less peritoneal trauma than does conventional laparotomy and may result in decreased adhesion formation. We present a review of the available data on laparoscopy and adhesion formation, as well as laparoscopic adhesiolysis. We also review current adjuvant techniques that may be used by practicing laparoscopists to prevent adhesion formation. DATABASE: A Medline search using "adhesions," "adhesiolysis," and "laparoscopy" as key words was performed for English-language articles. Further references were obtained through cross-referencing the bibliography cited in each work. DISCUSSION: The majority of studies indicate that laparoscopy may reduce postoperative adhesion formation relative to laparotomy. However, laparoscopy by itself does not appear to eliminate adhesions completely. A variety of adjuvant materials are available to surgeons, and the most recent investigation has demonstrated significant potential for intraperitoneal barriers. Newer technologies continue to evolve and should result in clinically relevant reductions in adhesion formation.     

The role of laparoscopic adhesiolysis in chronic abdominal pain

BACKGROUND: Intraperitoneal adhesions seem to be a possible cause of chronic abdominal pain, but reports of their etiological role are controversial. Laparoscopic adhesiolysis has been proposed as treatment of choice, even tough reports of success are contradictory. The aim of our prospective study, was to determine whether laparoscopic adhesiolysis ameliorates chronic abdominal pain in patients with pathological abdominal adhesions. METHODS: Forty-five patients with chronic abdominal pain, lasting for more than 6 months, without abnormal findings other than pathological intraperitoneal adhesions found at laparoscopy, underwent laparoscopic adhesiolysis. RESULTS: Forty-one patients (91.1%) were available for follow-up after an average time interval of 18 months (range: 12-41 months): 24 patients (58.5%) were free from abdominal pain; 10 (24.4%) reported significant amelioration of pain, while 7 (17.1%) patients had no amelioration. CONCLUSIONS: Laparoscopy is an efficient means of assessing patients with chronic abdominal pain, and laparoscopic adhesiolysis cures or ameliorates. Chronic abdominal pain in more than 80% of patients.     

A comparative study of postoperative adhesion formation after laparoscopic vs open cholecystectomy

BACKGROUND: There is little evidence in the literature to support a lower incidence of adhesion formation following laparoscopic surgery rather than laparotomy. Adhesion formation after laparotomy has been well studied, but we believe that the decrease or absence of adhesions following laparoscopic surgery is underreported. Therefore, we set out to evaluate adhesion formation following laparoscopic cholecystectomy (LC) compared with open cholecystectomy (OC). METHODS: Group A consisted of 18 patients who underwent a second laparoscopy due to various intraabdominal diseases after an LC had already been performed. Group B consisted of eight patients who underwent laparoscopy due to various intraabdominal diseases after an open cholecystectomy performed at an earlier date. In both groups, the frequency, extent, and thickness of adhesions were evaluated according to a standardized scoring system. RESULTS: Ten patients in group A (55.5%) had no adhesion formation either on the treated side of the previous LC or on the trocar entry sites. Three patients (16.6%) had minimal adhesions on the treated side of the previous LC, but no adhesions were observed at the trocar entry sites. Five patients (27.7%) had loose, easily separable adhesions on the treated site of the previous LC and at the trocar entry sites. All eight patients in group B (100%) had thick and extensive adhesions either on the treated side of the previous open cholecystectomy or the anterior abdominal wall below the surgical incision. CONCLUSION: This comparative clinical study suggests that LC results in less adhesion formation, either on the operative or at the trocar entry sites, than open cholecystectomy.     

Laparoscopic management of recurrent adhesive small-bowel obstruction: Long-term follow-up

Purpose  To evaluate the efficiency, safety, and outcome of laparoscopic adhesiolysis for recurrent small-bowel obstruction (SBO), when performed early after failed conservative treatment. Methods  Between 1999 and 2005, elective laparoscopic adhesiolysis was attempted in 46 patients with recurrent SBO after abdominal or pelvic surgery. Laparoscopic adhesiolysis was done during the acute onset of SBO after the patient failed to respond to 24 h of conservative treatment. Results  Fifteen patients (32.6%) presented with recurrent SBO and 31 patients (67.4%) presented with recurrent SBO and chronic abdominal pain. Postoperative adhesions were identified laparoscopically in all patients: as isolated bands in 11 patients, enteroperitoneal angulation in 12 patients, entero-enteral angulation in 17 patients, and extensive dense and matted intra-abdominal adhesions in 6 patients. Successful complete laparoscopic adhesiolysis was achieved in 42 of the 46 patients (91.3%). Conversion to minilaparotomy was required for a convoluted mass of adherent bowel in one patient (2.2%) and laparotomy was required for extensive dense and matted adhesions in three patients (6.5%). The mean follow-up was 46.5 months (range 24–89 months). Forty-three patients (93.5%) were asymptomatic after the operation. Only one patient (2.2%) had a further two episodes of SBO over 38 months of follow-up. Conclusion  Laparoscopic intervention, when done early after the onset of symptoms, is highly feasible, safe, and effective in selected patients with recurrent SBO caused by postoperative adhesion. Q. Wang, Z.Q. Hu, W.J. Wang, and J. Zhang contributed equally to this work.     

Laparoscopic Lysis of Adhesions

Background Intra-abdominal adhesions constitute between 49% and 74% of the causes of small bowel obstruction. Traditionally, laparotomy and open adhesiolysis have been the treatment for patients who have failed conservative measures or when clinical and physiologic derangements suggest toxemia and/or ischemia. With the increased popularity of laparoscopy, recent promising reports indicate the feasibility and potential superiority of the minimally invasive approach to the adhesion-encased abdomen. Methods The purpose of this study was to assess the outcome of laparoscopic adhesiolysis and to provide technical tips that help in the success of this technique. Results The most important predictive factor of adhesion formation is a history of previous abdominal surgery ranging from 67%–93% in the literature. Conversely, 31% of scars from previous surgery have been free of adhesions, whereas up to 10% of patients without any prior surgical scars will have spontaneous adhesions of the bowel or omentum. Most intestinal obstructions follow open lower abdominopelvic surgeries such as colectomy, appendectomy, and hysterectomy. The most common complications associated with adhesions are small bowel obstruction (SBO) and chronic pain syndrome. The treatment of uncomplicated SBO is generally conservative, especially with incomplete obstruction and the absence of systemic toxemia, ischemia, or strangulation. When conservative treatment fails, surgical options include conventional open or minimally invasive approaches; the latter have become increasing more popular for lysis of adhesions and the treatment of SBO. Generally, 63% of the length of a laparotomy incision is involved in adhesion formation to the abdominal wall. Furthermore, the incidence of ventral hernia after a laparotomy ranges between 11% and 20% versus the 0.02%–2.4% incidence of port site herniation. Additional benefits of the minimally invasive approaches include a decreased incidence of wound infection and postoperative pneumonia and a more rapid return of bowel function resulting in a shorter hospital stay. In long-term follow up, the success rate of laparoscopic lysis of adhesions remains between 46% and 87%. Operative times for laparoscopy range from 58 to 108 minutes; conversion rates range from 6.7% to 43%; and the incidence of intraoperative enterotomy ranges from 3% to 17.6%. The length of hospitalization is 4–6 days in most series. Conclusions Laparoscopic lysis of adhesions seems to be safe in the hands of well-trained laparoscopic surgeons. This technique should be mastered by the advanced laparoscopic surgeon not only for its usefulness in the pathologies discussed here but also for adhesions commonly encountered during other laparoscopic procedures.     

Laparoscopic adhesiolysis for chronic abdominal pain: an objective assessment

BACKGROUND AND PURPOSE: Postoperative adhesions frequently occur and can account for various symptoms, including chronic abdominal pain. Conventional adhesiolysis by laparotomy results in an unacceptably high rate of recurrence. A minimally invasive procedure (laparoscopic adhesiolysis) might improve the outcome by inflicting less surgical trauma, but well-documented reports focused on laparoscopic adhesiolysis for chronic abdominal pain are lacking. PATIENTS AND METHODS: Twelve consecutive patients with chronic abdominal pain caused by adhesions who were treated by laparoscopic adhesiolysis were assessed preoperatively and during a 1-year follow-up period applying validated scoring systems: McGill and SLC-90 tests to evaluate personalities and MOS SF-36 and GIQLI questionnaires for the quality of life assessments. RESULTS: No psychological influences were identified. Only two patients experienced a lasting improvement in quality of life, and five patients had more or less stable complaints. Five patients required laparotomy within a year after laparoscopic adhesiolysis. CONCLUSIONS: Laparoscopic adhesiolysis has yet not passed the stage of clinical trial and requires objective evaluation, including detailed information on recurrence and de novo adhesions in correlation with clinical outcome.     

Adhesions after abdominal surgery: a systematic review of the incidence,distribution and severity

Abdominal adhesions are associated with increased postoperative complications, cost and workload. We performed a systematic review with statistical pooling to estimate the formation rate, distribution and severity of postoperative adhesions in patients undergoing abdominal surgery. A literature search was carried out for all articles reporting on the incidence, distribution and severity of adhesions between January 1990 and July 2011. Twenty-five articles fulfilled the inclusion criteria. The weighted mean formation rate of adhesions after abdominal surgery was 54 % (95 % confidence interval [CI] 40–68 %), and was 66 % (95 % CI 38–94 %) after gastrointestinal surgery, 51 % (95 % CI 40–63 %) after obstetric and gynaecological surgery and 22 % (95 % CI 7–38 %) after urological surgery. The mean overall severity score was 1.11 ± 0.98 according to the Operative Laparoscopy Study Group classification. Laparoscopic surgery reduced the adhesion formation rate by 25 % and decreased the adhesion severity score (laparoscopic; 0.36 ± 0.69 vs. open; 2.14 ± 0.84) for gastrointestinal surgery. Our results demonstrate that the incidence and severity of abdominal adhesions varies between surgical specialties and procedures. An increased awareness of adhesions can help in identifying the underlying mechanisms of adhesion formation and novel therapeutic approaches, while also improving the surgical consent process.     

An evaluation of laparoscopic adhesiolysis in patients with chronic abdominal pain

The purpose of this prospective study was to determine whether laparoscopic adhesiolysis ameliorates chronic abdominal pain in patients with abdominal adhesions. Forty-five patients with chronic abdominal pain lasting for more than 6 months but with no abnormal findings other than adhesions found at laparoscopy underwent laparoscopic adhesiolysis. Thirty-six patients (80%) were available for follow-up after a median time interval of 10 months (range: 6–36 months). Seventeen patients (47.2%) were free from abdominal pain and 13 patients (36.1%) reported significant amelioration of their pain. Six (16.6%) patients had no amelioration. Twenty-nine patients (80.6%) judged the outcome of the operation to be good or beneficial and 35 (97.2%) said that they would undergo the operation a second time if that were necessary. Laparoscopy is an effective tool for the evaluation of patients with chronic abdominal pain, and laparoscopic adhesiolysis cures or ameliorates chronic abdominal pain in more than 80% of patients.     

Comparison of Peristomal Adhesion Formation Between Laparoscopic and Open Low Anterior Resection of Rectal Cancer

Background

Postoperative adhesions appear to be less common following laparoscopic surgery than after conventional open surgery. The purpose of this study was to compare the impact of laparoscopic and conventional open rectal surgery on peristomal adhesion formation.

Methods

We enrolled 97 subjects who were participants in a trial comparing open versus laparoscopic surgery for mid and low rectal cancer after neoadjuvant chemoradiotherapy. These patients had undergone rectal cancer surgery with ileostomy formation. Peristomal adhesions were assessed during ileostomy takedown using an adhesion grading system: (1) no adhesions or fine, filmy adhesions separable by blunt dissection; (2) dense adhesions, separable by sharp dissection; (3) very dense adhesions, resulting in enterotomy and/or requiring extension of the abdominal wall incision.

Results

A total of 57 patients underwent laparoscopic resection (group A) and 40 underwent open resection (group B). Operating time for ileostomy dissection was shorter in group A than in group B (14.6 vs. 19.8 min, respectively; p = 0.047). Dense adhesions (grades 2 and 3) were more common in group B (22/40, 55 %) than in group A (12/57, 21 %; p < 0.001). In particular, grade 3 adhesions were present only in group B (6/40).

Conclusions

The present findings suggest that laparoscopic rectal surgery results in less peristomal adhesion formation than does conventional open surgery.