• Stommel Martijn W J MWJ Department of Surgery, Radboud university medical center, Nijmegen, The Netherlands., Ten Broek Richard P G RPG Department of Surgery, Radboud university medical center, Nijmegen, The Netherlands., Chema Strik, Gerrit D Slooter, Cornelis Verhoef, Dirk J Grünhagen, Peter van Duijvendijk, Bemelmans Marc H A MHA Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands., Marcel den Dulk, Colin Sietses, van Heek Tjarda N T TNT Department of Surgery, Gelderse Vallei Hospital, Ede, The Netherlands., Peter B van den Boezem, de Wilt Johannes H W JHW Department of Surgery, Radboud university medical center, Nijmegen, The Netherlands., and Harry van Goor.
• Department of Surgery, Radboud university medical center, Nijmegen, The Netherlands.
• Ann. Surg. 2018 Apr 1; 267 (4): 743-748.

ObjectiveThe aim of this study was to compare adhesion formation after laparoscopic and open colorectal cancer resection.Summary Of Background DataAfter colorectal surgery, most patients develop adhesions, with a high burden of complications. Laparoscopy seems to reduce adhesion formation, but evidence is poor. Trials comparing open- and laparoscopic colorectal surgery have never assessed adhesion formation.MethodsData on adhesions were gathered during resection of colorectal liver metastases. Incidence of adhesions adjacent to the original incision was compared between patients with previous laparoscopic- and open colorectal resection. Secondary outcomes were incidence of any adhesions, extent and severity of adhesions, and morbidity related to adhesions or adhesiolysis.ResultsBetween March 2013 and December 2015, 151 patients were included. Ninety patients (59.6%) underwent open colorectal resection and 61 patients (40.4%) received laparoscopic colorectal resection. Adhesions to the incision were present in 78.9% after open and 37.7% after laparoscopic resection (P < 0.001). The incidence of abdominal wall adhesions and of any adhesion was significantly higher after open resection; the incidence of visceral adhesions did not significantly differ. The extent of abdominal wall and visceral adhesions and the median highest Zühlke score at the incision were significantly higher after open resection. There were no differences in incidence of small bowel obstruction during the interval between the colorectal and liver operations, the incidence of serious adverse events, and length of stay after liver surgery.ConclusionLaparoscopic colorectal cancer resection is associated with a lower incidence, extent, and severity of adhesions to parietal surfaces. Laparoscopy does not reduce the incidence of visceral adhesions.

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