California Northstate University College of Medicine, Elk Grove, CA, USA.
Department of Surgery, Sutter Roseville Medical Center, Roseville, CA, USA.
Am Surg. 2024 Nov;90(11):3082-3091. doi: 10.1177/00031348241258718. Epub 2024 May 25.
Adhesions are a feared complication of abdominal surgery. There have been many new adhesion barriers developed and tested; however, there is no recent systematic review analyzing all the published literature. To address this, we aimed to analyze the different types of adhesion barriers, and determine their effects on postoperative outcomes in patients.
A total of 14,038 articles utilizing adhesion barriers in abdominal surgery were retrieved from the PubMed, EMBASE, and Scopus databases. Inclusion criteria were: patients undergoing abdominal surgery, patients receiving an adhesion barrier, and reported postoperative outcomes. Two reviewers independently screened titles/abstracts and full-text articles using Covidence. The ROBINS-I tool was used to assess the quality of the included studies. Study protocol: Prospero CRD42023458230.
A total of 20 studies, with no overall high risk of bias, with 171,792 patients were included. Most studies showed an equivocal benefit for adhesion barriers, with no singular adhesion barrier type that had definitive superior outcomes compared to the others. Bioresorbable barriers emerged as the most extensively researched adhesion barrier type, exhibiting promising results in colorectal surgery. Starch-based adhesion barriers also exhibited a reduction in overall postoperative bowel obstructions and may be beneficial for stoma sites and port closures. On the other hand, many studies raised concerns regarding complications, including risk of abscess formation, fistula development, peritonitis, and anastomotic leakage.
Adhesion barriers should be considered on a case-by-case basis, however, they should not be utilized prophylactically in all abdominal surgeries due to their risk of complications.
粘连是腹部手术的一种可怕并发症。已经开发和测试了许多新的粘连屏障，但没有最近的系统评价分析所有已发表的文献。为了解决这个问题，我们旨在分析不同类型的粘连屏障，并确定它们对患者术后结果的影响。
从 PubMed、EMBASE 和 Scopus 数据库中检索了 14038 篇利用腹部手术中粘连屏障的文章。纳入标准为：接受腹部手术的患者、接受粘连屏障的患者和报告术后结果的患者。两名审查员使用 Covidence 独立筛选标题/摘要和全文文章。使用 ROBINS-I 工具评估纳入研究的质量。研究方案：Prospero CRD42023458230。
共有 20 项研究，整体无高偏倚风险，纳入了 171792 名患者。大多数研究表明粘连屏障的效果不确定，没有单一类型的粘连屏障在与其他类型相比具有明确的优势结果。生物可吸收屏障是研究最多的粘连屏障类型，在结直肠手术中显示出有希望的结果。淀粉基粘连屏障也显示出减少总体术后肠阻塞的效果，并且可能对造口部位和端口闭合有益。另一方面，许多研究对并发症提出了担忧，包括脓肿形成、瘘管发展、腹膜炎和吻合口漏的风险。
粘连屏障应根据具体情况考虑，但由于其并发症风险，不应在所有腹部手术中预防性使用。
