• William B Robb and Christophe Mariette.
• 1Department of Digestive and Oncological Surgery, University Hospital of Lille, Lille, France 2University of Lille - Nord de France, Lille, France 3Inserm, UMR837, Jean-Pierre Aubert Research Center, Team 5 Mucins, Epithelial Differentiation and Carcinogenesis, Lille, France 4SIRIC (Sites de Recherche Intégrée sur le Cancer) Lille, France.
• Dis. Colon Rectum. 2014 Oct 1; 57 (10): 1228-40.

BackgroundPostoperative intra-abdominal adhesions after GI surgery constitute a major burden for health care provision globally, causing chronic abdominal symptoms and necessitating repeated surgical intervention.ObjectiveThis systematic review examines safety and efficacy data for current anti-adhesion strategies after GI surgery.Data SourcesPubMed, 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 SelectionA list of predefined search terms was combined with the Cochrane Highly Sensitive Search Strategy to identify studies.InterventionThe use of an anti-adhesion strategy was investigated.Main Outcome MeasuresThe 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.ResultsIn 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.LimitationsThe 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.ConclusionsLimiting 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.

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