THE RATES OF ADHESION DEVELOPMENT AND THE EFFECTS OF CRYSTALLOID SOLUTIONS ON ADHESION DEVELOPMENT IN PELVIC-SURGERY

Objective: To document rates of adhesion development after abdomino-pe lvic surgery, stratified by adhesion type, access method, and use of c rystalloid solution instillates. Design: Reports from a MEDLINE search (1/1/1966-12/18/1996) detailing rates of adhesion development and mee ting the inclusion criteria were subjected to meta-analysis. Setting: Meta-analysis. Patient(s): Patients undergoing abdomino-pelvic surgery . Intervention(s): Intraperitoneal crystalloid solution instillates. M ain Outcome Measure(s): Percentage adhesion-free outcome in patients ( ''patients'') or surgical sites (''sites''). Result(s): Adhesion-free outcome (sites) was lowest for reformed (26.3% laparotomy; 14.3% lapar oscopy), higher for de novo Ib (direct trauma) (45.2% laparotomy, 37.2 % laparoscopy), and highest for de novo la (indirect trauma) adhesions (82.4% laparoscopy). Crystalloid solution instillates reduced adhesio n-free outcome at sites (45.2% versus 20% de novo Ib adhesions in lapa rotomy) and in patients (43.5% versus 19.9% reformed, laparotomy; 71.7 % versus 25% de novo Ib, laparoscopy). Conclusion(s): Adhesion-free ou tcome was lowest for reformed, higher for de novo Ib, and highest for de novo la adhesions. Surprisingly, it was lower in laparoscopy than i n laparotomy for de novo Ib and reformed adhesions. Crystalloid instil lates did not increase adhesion-free outcome. Although limited by the retrospective and heterogeneous nature of the data, these conclusions nonetheless provide a basis on which to formulate future hypotheses. ( Fertil Steril(R) 1998;70:702-11. (C) 1998 by American Society for Repr oductive Medicine.).