the incidence of postoperative obstructions due to adhesions are declining due to laparoscopy ?
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- Answered 27 Aug 2019 Conflict of interest declaration: None With correspondence with the ‘asker’ the Q has been re-worded to “The incidence of emergency surgery due to intestinal obstruction due to postoperative adhesions is declining. Is this due to laparoscopy?” There are a number of papers exploring laparoscopy and postoperative adhesions and/or blockages. For instance, this 2017 paper “Small bowel obstruction and incisional hernia after laparoscopic and open colorectal surgery: a meta-analysis of comparative trials.”  reports: “Laparoscopic surgery is associated with a significant reduction in both SBO and IH compared to the open approach. A low conversion rate in the laparoscopic group plays a key role for reduction in both SBO and IH.” A 2013 BMJ article “Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis”  states: “The incidence of adhesive small bowel obstruction was significantly lower in 29 laparoscopic cohorts (1.4%, 1.0% to 1.8%; I2=86%) than in 54 open surgery cohorts (3.8%, 3.1% to 4.4%; I2=82%). The incidence of adhesive small bowel obstruction was also lower after laparoscopic surgery in 10 studies that directly compared laparoscopic and open surgery (odds ratio 0.38, 95% confidence interval 0.16 to 0.91; I2=37%).” Also reporting “Notably, laparoscopy does not totally prevent adhesion formation, contradicting the opinion that the use of anti-adhesive barriers is not needed in laparoscopy.” Probably the closest match to the question was the 2016 paper “Adhesive small bowel obstruction after laparoscopic and open colorectal surgery: a systematic review and meta-analysis”  which concluded: “This meta-analysis shows that laparoscopic colorectal surgery significantly reduced the incidence of adhesive SBO and the rate of subsequent surgery for adhesive SBO compared with open surgery. Despite these findings, however, well designed, multicenter randomized trials are needed to confirm the benefit of laparoscopic colorectal surgery.” Although it doesn’t specifically mention emergency surgery. References 1) https://www.ncbi.nlm.nih.gov/pubmed/27287910 2) https://www.bmj.com/content/347/bmj.f5588.long 3) https://www.sciencedirect.com/science/article/abs/pii/S0002961016302203