7 is indeed an influential study. the authors of the recent Cochrane review 10 recognized that the inclusion of a subgroup of patients (90 of 1791 patients operated on for bowel obstruction rather than having an open digestive tract resection) in meta-analysis significantly affected the point estimate of effect on time to recurrent surgery for intestinal obstruction. We have published a systematic review without such meta-analysis, and whether this subgroup is a distinct patient group that warrants separate consideration is a moot point.We feel strongly that we provide an objective and comprehensive systematic review with well-balanced and conservative conclusions, which are unchanged by this correspondence. We reiterate that more evidence is needed regarding the efficacy of all antiadhesion strategies in reducing chronic abdominal symptoms, avoiding repeated operative interventions, and improving quality of life.
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