Prevention of adhesive small bowel obstruction by anti-adhesion barriers: do they really work?

Postoperative intraabdominal adhesions remain one of the most common and clinically significant complications following abdominal and pelvic surgery. Adhesions contribute to adhesive small bowel obstruction (aSBO), chronic abdominal pain, infertility, and increased healthcare costs. Despite decades of research, the clinical value and routine adoption of anti-adhesion barriers remain subject to debate. This review critically examines the role of anti-adhesion barriers in preventing aSBO, focusing on their mechanisms, efficacy, limitations, and emerging developments. Multiple barriers consistently reduce adhesion formation in clinical trials. Albeit limited, there is also evidence for a significant reduction in clinically meaningful outcomes-such as aSBO, infertility, or chronic pain-for some barriers. Registry data highlight a persistent burden of adhesion-related readmissions after intraabdominal surgery, whereas real-world barrier utilization remains low. Cost-effectiveness analyses suggest potential benefit primarily in open colorectal surgery. Future progress will depend on standardized outcome reporting, multicenter randomized controlled trials with long-term follow-up, and targeted, risk-stratified application of anti-adhesion barriers.