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Adhesion Prophylactic Agents Reduce Early and Late Small Bowel Obstruction

Summary by Christopher DuCoin, MD, FACS

September 9, 2025

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Huy TC, Bercz AP, Bailey AM, et al. Efficacy of Prophylactic Agents in Preventing Adhesive Small Bowel Obstruction: A Systematic Review and Meta-Analysis. J Am Coll Surg. 2025: in press.

Post operative small bowel obstruction remains a significant cause of postoperative morbidity, readmission, and need for reoperation. In this study, the incidence of late adhesive bowel obstructions ranged from 0% to 20%, depending on procedure and whether adhesion prophylaxis was used.

This study is a meta-analysis of multiple randomized controlled trials and observation studies and was able to show a decrease in early and late postoperative small bowel obstruction with the use of adhesion prophylactic agent, with an odds ratio of 0.4 for early and 0.6 for late obstructions.

Both solid and liquid or hydrogel adhesion barriers were studied. Only Seprafilm and Guardix had enough data to be involved in the meta-analysis.

On subsequent subset analysis, it was also found that Seprafilm had no difference in late bowel obstruction, defined as more than 30 days, while Guardix was the only product to show a decrease in late bowel obstructions following open and laparoscopic procedures with an odds ratio of 0.34.

Given the scope of this problem and the limited data currently available, further research is necessary to identify the varying efficacy and cost-effectiveness for routine use of these products.

Note: This work was supported by the ACS Surgical Adhesions Improvement project.

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