Adhesion barriers reduce postoperative adhesions, but evidence does not support routine use

A systematic review and meta-analysis published in the World Journal of Surgery evaluated adhesion barriers for preventing postoperative adhesions after abdominopelvic surgery. Searches of CENTRAL, EMBASE and MEDLINE through January 15, 2025 identified 36 parallel-arm randomized controlled trials involving 6,729 patients. Studies involving patients with pre-existing adhesions were excluded.

Adhesion barriers reduced adhesions at second-look assessment compared with controls (21 trials, 2,351 patients; odds ratio [OR] 0.37, 95% CI 0.30–0.45), with moderate-certainty evidence and moderate heterogeneity (I² = 51%). Reductions were seen in both general surgery and obstetrics and gynecology subgroups. Postoperative small bowel obstruction was modestly reduced (12 trials, 4,917 patients; OR 0.81, 95% CI 0.66–0.99).

Pooled analyses found no statistically significant differences in anastomotic leakage, abscess formation, wound infection, adhesion severity, intraoperative blood loss, or time between initial and second surgery. Index operations were longer with barriers, although this analysis showed very high heterogeneity (I² = 99%).

The authors caution that the review pooled eight heterogeneous agent classes and varied procedures against an inconsistently scored surrogate outcome. They conclude that evidence is insufficient to recommend routine use or identify which patients and procedures warrant treatment. Use should remain individualized pending adequately powered, agent-specific trials with standardized scoring and patient-centered endpoints. This report is based on the abstract; full text was unavailable.