Multicenter Observational Study of Adhesion Formation After Open-and Laparoscopic Surgery for Colorectal Cancer

Martijn W. J. Stommel*, Richard P. G. ten Broek, Chema Strik, Gerrit D. Slooter, Cornelis Verhoef, Dirk J. Grunhagen, Peter van Dutjvendijk, Marc H. A. Bemelmans, Marcel den Dulk, Colin Sietses, Tjarda N. T. van Heek, Peter B. van den Boezem, Johannes H. W. de Wilt, Harry van Goor

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objective: The aim of this study was to compare adhesion formation after laparoscopic and open colorectal cancer resection. Summary of Background Data: After 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. Methods: Data 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. Results: Between 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 Zuhlke 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. Conclusion: Laparoscopic 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.
Original languageEnglish
Pages (from-to)743-748
Number of pages6
JournalAnnals of Surgery
Issue number4
Publication statusPublished - 1 Apr 2018


  • colorectal cancer
  • colorectal surgery
  • laparoscopic surgery
  • postoperative adhesions

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