OBJECTIVES: Previous European research has shown that laparoscopic surgery is frequently complicated by the need for adhesiolysis due to adhesions caused by previous surgery. In Europe this increases surgery time and post-operative stay, and in the longer-term can adversely affect patient outcomes. As part of a program to assess the burden of adhesions in the USA we assessed the short-term additional costs of common laparoscopic gynecological operations including adhesiolysis. METHODS: The Premier database provides detailed hospital cost accounting data from over 500 centers across the USA. A cohort of patients undergoing gynecological laparoscopic surgery between 2004-2006, including ovarian procedures, was selected by ICD9-CM and identified on discharge. Those patients undergoing adhesiolysis secondary to another procedure were also identified. All discharges were classified as inpatient or outpatient. Mean total costs, surgery cost and mean length of stay (LOS) were determined for each procedure and sub-group, with and without adhesiolysis. Regression analyses were undertaken to test for significant differences between procedures, with and without adhesiolysis. RESULTS: A total of 7928 inpatient and 6820 outpatient discharges for laparoscopic ovarian procedures (with total costs) were identified. 30.8% and 33.6% included adhesiolysis. The additional costs of adhesiolysis accounted for an extra 5.3% ($328) and 6.9% ($215) of total costs. Surgical costs accounted for 23.7% ($78) and 27.5% ($59) of additional costs. Both total and surgery costs were significantly higher for the same procedure with adhesiolysis compared to that without (P<0.0001). The mean LOS for inpatients was significantly longer with adhesiolysis (2.35 d) than without (2.02 d), (P<0.0001). CONCLUSIONS: This study confirms previous European research that adhesiolysis occurs in approximately one third of ovarian laparoscopic procedures and results in additional hospital costs and longer LOS. While the long-term outcome burden of adhesiolysis has been demonstrated by the SCAR study in Scotland, the impact in the USA needs further exploration.