ABSTRACT
The second-look procedure can be divided into three separate components. As with the initial surgical evaluation, the first step is abdominal entry, restoration of normal anatomy, and evaluation of the peritoneal cavity. Unlike primary evaluation, adhesions often markedly hinder this process. Indeed, in some cases the adhesions can be so dense that incidental enterotomy may occur upon attempted abdominal entry. Adhesions can be due to either postoperative changes or to microscopic tumor deposits. Biopsies should be taken from the adhesions and sent for pathologic evaluation. Upon abdominal entry, washings are also taken to be assessed for microscopic cytologic evidence of disease.
