The Extent and Severity of Adhesions Are Reduced After Major Laparoscopic Colorectal Surgery: A Pilot Study

Background: Adhesion formation after colorectal surgery is a well-recognized problem, and the ability of the laparoscopic technique to reduce adhesion formation is questionable. The present study compares adhesion formation after laparoscopic and open colorectal surgery. Patients and Methods: A diagnostic laparoscopy was performed through the stoma site at the ileostomy closure operation in patients who had undergone low anterior resection or ileal pouch anal-anastomosis. The laparoscopy was videorecorded, and the extent and severity of adhesions involving incisions, omentum, small bowel, and female adnexa were graded. Results: Twenty-three patients were enrolled into the study, and after exclusions 19 patients remained for the analyses. There was no difference in baseline characteristics of patients except in the mean (range) total incision length, which was 22 (21-23) cm in the open group and 10.9 (9-14) cm in the laparoscopic group (P<.001). The median (range) overall adhesion severity score was 7 (3-9) in the open group and 0 (0-4) in the laparoscopic group (P=.001). Similar differences were seen in overall extent and total score (P=.001 and P=.001, respectively). In detailed analysis, incision and small bowel adhesions scores were also statistically significantly different, favoring laparoscopic surgery. Conclusions: According to the present study, although low in number of patients, laparoscopic colorectal surgery may result in fewer adhesions compared with open surgery.