Postoperative Adhesion Prevention with Hyaluronic Acid-Based Barriers in Abdominal Surgery

Abstract

Introduction: Intra-abdominal adhesions develop in >90% of patients after open abdominal surgery, causing bowel obstruction, chronic pain, and infertility. Barrier agents may reduce adhesion formation but evidence on long-term outcomes is mixed. Methods: Systematic review of 12 randomized controlled trials (RCTs) (n=2,105) comparing hyaluronic acid/carboxymethylcellulose (HA/CMC) film versus no barrier. Primary outcome: adhesion extent at second-look laparoscopy or reoperation. Secondary: bowel obstruction rates. Results: HA/CMC significantly reduced adhesion severity (mean difference -1.8 on 4-point scale, 95% CI -2.4 to -1.2) and extent (OR 0.31, p<0.001). Adhesion-related small bowel obstruction occurred in 3.2% (barrier) vs 9.7% (control) (RR 0.33, p<0.001). No difference in chronic pain. Anastomotic leak rates were similar (0.4% vs 0.3%). Discussion: HA/CMC is effective in high-risk procedures (colorectal, gynecologic), but efficacy is reduced in contaminated fields. Cost-effectiveness requires preventing one obstruction per ~30 cases. Conclusion: Routine use of HA/CMC barriers reduces adhesion-related bowel obstruction without increasing anastomotic complications.