INCIDENCE OF POSTOPERATIVE ADHESION FORMATION AFTER TRANSPERITONEAL GENITOURINARY LAPAROSCOPIC SURGERY JOHN G. PATTARAS, ROBERT G. MOORE, JAIME LANDMAN, RALPH V. CLAYMAN, GUNTER JANETSCHEK, ELSPETH M. MCDOUGALL, STEVEN G. DOCIMO, RAUL O. PARRA, AND LOUIS R. KAVOUSSI ABSTRACT Objectives. To evaluate adhesion formation after urologic laparoscopy, a multi-institutional review was conducted among adult patients who underwent a second procedure after an initial transperitoneal lapa- roscopic procedure. Adhesion formation after abdominal surgery remains a major cause of postoperative morbidity. Peritoneal adhesions result in hospitalizations and interventions that result in healthcare costs of more than 1 billion dollars annually. The risk of adhesion formation from transperitoneal genitourinary laparoscopy in adults has not been previously studied. Methods. Twenty-seven patients (mean age 45.5 years, range 24 to 71) were identified who underwent a second laparoscopic procedure after their initial urologic laparoscopic procedure was performed. The mean time between the procedures was 11.4 months (range 8 days to 38 months). At the time of the repeated laparoscopy or open surgery, the peritoneal cavity was examined and mapped for type (grade), extent (length), and location of any adhesions at the operative and trocar sites. The adhesions were graded as 0, no adhesions; 1, flimsy; 2, dense; and 3, cohesive. The extent was graded as 0, no adhesions; 1, less than 2 cm; 2, 2.1 to 10 cm; 3, greater than 10.1 cm. Results. Overall, adhesions occurred in 6 (22.2%) of 27 patients. Operative site adhesions occurred in only 3 (8.2%) of 34 possible operative sites (gastric augmentation cystoplasty, renal cyst ablation, nephropexy). Trocar site adhesions occurred in 4 (3.5%) of 114 possible sites (two nephrectomies, one cyst decortication, and one orchiectomy). All adhesions were classified as grade 1 and extent 1, except for a single grade 2, extent 2 adhesion. In most patients, retroperitonealization occurred with minimal or no scarring noted. None of the patients developed symptoms as a result of the adhesion formation. Conclusions. Although intraperitoneal adhesions do occur with adult urologic laparoscopy, the incidence is low. Also, in the few patients who do form adhesions, they are flimsy and short. This evidence, when contrasted with the available data on adhesion formation after open surgery, suggests that transperitoneal laparoscopic approaches to genitourinary surgery may have advantages over traditional open transperito- neal approaches by lowering the incidence and severity of adhesion formation. UROLOGY 59: 37–41, 2002. © 2002, Elsevier Science Inc. I ntraperitoneal adhesion formation is a well-rec- ognized consequence of abdominal and pelvic surgery. Of all hospital readmissions, 5% to 7% result directly from complications of adhesions, with 3% to 8% of these admissions managed oper- atively. 1 More than 300,000 hospitalizations and more than 800,000 inpatient days were attributed to adhesiolysis in the United States in 1994. 2 The From the Department of Urology, Emory University, Atlanta, Georgia; Division of Urology, Saint Louis University, Saint Louis, Missouri; Division of Urology, Washington University, Saint Louis, Missouri; Department of Urology, University of Vienna, Vienna, Austria; Division of Urology, Vanderbilt University, Nashville, Tennessee; Department of Urology, Mayo Clinic, Jack- sonville, Florida; and Department of Urology, Johns Hopkins Medical Institutions, Baltimore, Maryland Reprint requests: Robert G. Moore, M.D., Division of Urology, 3rd Floor, Saint Louis University, 3635 Vista Avenue at Grand Boulevard, Saint Louis, MO 63110 Submitted: March 2, 2001, accepted (with revisions): August 28, 2001 ADULT UROLOGY © 2002, ELSEVIER SCIENCE INC. 0090-4295/02/$22.00 ALL RIGHTS RESERVED PII S0090-4295(01)01474-1 37