Adhesions after open and laparoscopic abdominal surgery

In the SCAR update, Pepijn Krielen and colleagues1Krielen P Stommel MWJ Pargmae et al.Adhesion-related readmissions after open laparoscopic surgery: a retrospective cohort study (SCAR update).Lancet. 2020; 395: 33-41Summary Full Text PDF PubMed Scopus (20) Google Scholar suggested that abdominal surgery reduces incidence of adhesion-related readmissions. linked Comment, Liane S Feldman Raul J Rosenthal argued for more widespread use surgery.2Feldman LS RJ Why is underutilised?.Lancet. 3-4Summary (0) Laparoscopic increasingly used3Lassen K Nymo Olsen F Søreide Benchmarking aggregated length stay cancers digestive system.BJS Open. 2018; 2: 246-253Crossref has advantages, such as reduced hospital stay, but it limitations too.4Strobel O Büchler MW pancreatoduodenectomy: safety concerns no benefits.Lancet Gastroenterol Hepatol. 2019; 4: 186-187Summary (11) We have about generalisability data size effect attributed to laparoscopy alone. The included broad spectrum surgical procedures with highly varying potential adhesion formation. Most (15 406 [71·6%] 21 519) concerned less complex like cholecystectomy (12 130 laparoscopies) appendicectomy (3276 laparoscopies). A small number colorectal resections (9006), few (1179 [13·1%]) which were done laparoscopically, associated most readmissions.1Krielen Inflammation (eg, appendicitis) might constitute risk adhesions increases severity inflammation; perforations occur in 20% patients appendicitis, regardless mode access. Although fewer complications appendicectomies than are reported, proposed difference limited first 2 years surgery.5Andersson RE Short-term long-term morbidity national cohort.Br Surg. 2014; 101: 1135-1142Crossref Anastomotic leaks (reported up 15% patients) increase independently method did not control selection or surgery; this decision be based on disease patient factors rather laparoscopy. 1822 (8·5%) 519 laparoscopies converted surgery, information was given whether these surgeries analysed (by intention treat) procedures. When right indications, reduce However, been proven causative protective effect. declare competing interests. Adhesion-related update)Laparoscopic overall burden remains high. With further expected future, at population level become larger. Further steps remain necessary postsurgical complications. Full-Text Adhesions – Authors' replyKjetil colleagues raise overestimating positive effects update.1 They highlight that, when comparing outcomes those case jeopardise results.