Strategies in the prevention of the formation of postoperative adhesions in digestive surgery: a systematic review of the literature

Dis Colon Rectum. 2014 Oct;57(10):1228-40. doi: 10.1097/DCR.0000000000000191.


Background: Postoperative intra-abdominal adhesions after GI surgery constitute a major burden for health care provision globally, causing chronic abdominal symptoms and necessitating repeated surgical intervention.

Objective: This systematic review examines safety and efficacy data for current anti-adhesion strategies after GI surgery.

Data sources: PubMed, Medline, and Embase databases were searched for randomized control trials and nonrandomized clinical studies of anti-adhesion products from January 1980 to October 2013.

Study selection: A list of predefined search terms was combined with the Cochrane Highly Sensitive Search Strategy to identify studies.

Intervention: The use of an anti-adhesion strategy was investigated.

Main outcome measures: The primary outcome was the safety profile of anti-adhesion products. Secondary outcomes included the analysis of the reduction in the incidence, extent, and severity of adhesions; incidence of bowel obstruction; quality-of-life data; and oncological outcomes.

Results: In total, 24 articles were included in the qualitative analysis: 17 randomized controlled trials and 7 nonrandomized studies, reporting on 5 anti-adhesion products. Data suggest that anti-adhesive products may be used safely; however, hyaluronic acid-based products should not be placed in contact with an anastomosis. The most studied product, a hyaluronic acid/carboxymethylcellulose membrane, reduces the incidence, extent, and severity of adhesions but without strong evidence of prevention of bowel obstruction.

Limitations: The size and quality of available studies varied greatly, reflected by the Jadad and MINORS scores. The majority of studies reported the use of a single product, hyaluronic acid/carboxymethylcellulose membrane.

Conclusions: Limiting adhesion formation after GI surgery is feasible. More evidence is needed regarding the efficacy in reducing chronic abdominal symptoms, repeated operative intervention, and improving quality of life.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Abdominal Abscess / chemically induced
  • Anastomotic Leak / chemically induced
  • Digestive System Diseases / complications
  • Digestive System Diseases / prevention & control*
  • Glucans / adverse effects
  • Glucans / therapeutic use
  • Glucose / adverse effects
  • Glucose / therapeutic use
  • Humans
  • Hyaluronic Acid / adverse effects
  • Hyaluronic Acid / therapeutic use*
  • Icodextrin
  • Ileus / prevention & control
  • Membranes, Artificial
  • Pulmonary Embolism / chemically induced
  • Severity of Illness Index
  • Tissue Adhesions / complications
  • Tissue Adhesions / prevention & control


  • Glucans
  • Membranes, Artificial
  • Seprafilm
  • Icodextrin
  • Hyaluronic Acid
  • Glucose