Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
背景：粘连是腹部手术的一种令人恐惧的并发症。已经开发和测试了许多新的粘附屏障；然而，没有最近的系统综述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，并确定其对患者术后结局的影响。
方法：从PubMed检索到在腹部手术中使用粘连屏障的总共14,038篇文章，EMBASE,和Scopus数据库。纳入标准为：接受腹部手术的患者，接受粘连屏障的患者，并报告术后结果。两名审稿人使用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:ProsperoCRD42023458230。
结果：共20项研究，总体上没有偏见的高风险，包括171,792名患者。大多数研究表明，粘连屏障有模棱两可的好处，没有单一的粘连屏障类型，与其他类型相比具有明显的优势。生物可吸收屏障是研究最广泛的粘连屏障类型，在结直肠手术中表现出有希望的结果。基于淀粉的粘连屏障还表现出术后总体肠梗阻的减少，并且可能有益于造口部位和端口闭合。另一方面,许多研究引起了对并发症的关注，包括脓肿形成的风险，瘘管发育，腹膜炎,吻合口漏.
结论：应根据具体情况考虑粘附障碍，然而,由于它们有并发症的风险，不应在所有腹部手术中预防性使用它们。
方法：从PubMed检索到在腹部手术中使用粘连屏障的总共14,038篇文章，EMBASE,和Scopus数据库。纳入标准为：接受腹部手术的患者，接受粘连屏障的患者，并报告术后结果。两名审稿人使用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:ProsperoCRD42023458230。
结果：共20项研究，总体上没有偏见的高风险，包括171,792名患者。大多数研究表明，粘连屏障有模棱两可的好处，没有单一的粘连屏障类型，与其他类型相比具有明显的优势。生物可吸收屏障是研究最广泛的粘连屏障类型，在结直肠手术中表现出有希望的结果。基于淀粉的粘连屏障还表现出术后总体肠梗阻的减少，并且可能有益于造口部位和端口闭合。另一方面,许多研究引起了对并发症的关注，包括脓肿形成的风险，瘘管发育，腹膜炎,吻合口漏.
结论：应根据具体情况考虑粘附障碍，然而,由于它们有并发症的风险，不应在所有腹部手术中预防性使用它们。
