**Abstract**

Hysterectomy sometimes is not as simple as removing the uterus. The most challenging condition before definitive hysterectomy is mostly an adhesion with various grade of severity and need a careful approach to prevent surrounding organ injury. Adhesions can be a significant source of morbidity in patients and provide a thorough overview of the etiology, pathophysiology, and clinical consequences. The authors provide a step-by-step approach including preoperative preparation, surgical techniques, and postoperative management. This chapter also explains the prevention of adhesions and the use of adhesion barriers. With contributions from leading experts in the field, it seems to be an essential resource for any surgeon seeking to optimize patient outcomes in laparotomy. This comprehensive guide might be used by surgeons to improve their understanding and technical skills in dealing with adhesions during laparotomy.

**Keywords:** adhesiolysis, hysterectomy, surgical techniques, adhesion, incision
