September 2021 · Volume 10 · Issue 9 Page 3560 International Journal of Reproduction, Contraception, Obstetrics and Gynecology Rani R et al. Int J Reprod Contracept Obstet Gynecol. 2021 Sep;10(9):3560-3574 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 Meta-analysis Using different surgical techniques and ideas to reduce post-operative adhesion formation: a systematic review and meta-analysis Rekha Rani*, Shikha Singh, Urvashi, Ruchika Garg INTRODUCTION Adhesion development is the most common sequelae of intra-abdominal and pelvic surgery and represents a significant cause of morbidity among post-operative patients. The incidence of adhesive small bowel obstruction (SBO) was 2%. Among patients with a known cause of SBO, adhesions were the single most common cause. 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 following pelvic surgery is also common and is a major cause of infertility in women. The mechanism by which adhesions cause infertility includes distortion of the normal ability of the fallopian tube to achieve ovum pickup following ovulation, which can be due to ovarian encapsulation by adhesions or limitations in tubal/fimbral potential for movement. It has been estimated that 22% of all infertility cases are attributable to adhesions. In one study, adhesions were found in 37% of infertile patients. In 15% of these cases, adhesions were the only factor identified as the cause of DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20213485 Department of Obstetrics and Gynaecology, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India Received: 15 July 2021 Revised: 08 August 2021 Accepted: 09 August 2021 *Correspondence: Dr. Rekha Rani, E-mail: drrekha.gynae@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Adhesion development is the most common sequelae of intra-abdominal and pelvic surgery. 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. This review contributed to the growing knowledge pool by elucidating factors that potentially predispose to the development of adhesions. A literature search was performed using the PubMed database for all relevant English language articles and were reviewed with particular attention to predisposing factors to post-operative adhesion development. In addition, the reference lists of each article were reviewed to identify additional relevant articles. Various factors have been shown to directly increase the risk of post- operative adhesion development; namely, certain genetic polymorphisms in the interleukin-1 receptor antagonist, increased estrogen exposure, and endometriosis. There were 28 papers with 27 studies included for a systematic review. Of these, 17 studies were eligible for meta-analysis and 11 for qualitative assessment only. None of the techniques that were compared significantly reduced the incidence of adhesive small bowel obstruction. In a small low-quality trial, the pregnancy rate increased after subserous fixation of suture knots. However, the incidence of adhesions was lower after laparoscopic compared with open surgery (relative risk (RR): 0.14; 95% confidence interval (CI): 0.03-0.61) and when the peritoneum was not closed (RR: 0.36; 95% CI: 0.21-0.63). None of the specific techniques that were compared reduced the two main adhesion-related clinical outcomes, small bowel obstruction and infertility. Keywords: Tissue adhesions, Laparoscopy, Peritoneal closure, Infertility, Small bowel obstruction