Don't Fear Adhesions: Safe Approaches for Reoperative Minimally Invasive Surgery

Experience in minimally invasive surgery has increased at a rapid pace, and previous abdominal surgery with adhesion formation is no longer considered a contraindication for laparoscopic surgery. Therefore, surgeons across all specialties should be well equipped to approach a reoperative abdomen with minimal complications and satisfactory patient outcomes. Previous abdominal scarring and adhesions present distinct challenges for surgeons performing minimally invasive surgery, and postsurgical adhesions are considered one of the main reasons for conversion from laparoscopy to laparotomy. In this review article, we present the influence of previous abdominal surgeries and pathogenesis of adhesion formation. Methods of laparoscopic entry and technical aspects of adhesiolysis to the ventral abdominal wall, intestinal, and pelvic adhesions are reviewed. Surgeons should have a keen sense of awareness of adhesion-related complications to reduce the morbidity of laparoscopic reoperations.