Efficacy of Prophylactic Agents in Preventing Adhesive Small Bowel Obstruction: A Systematic Review and Meta-Analysis

作者：Tess Huy, Aron Bercz, Angela M Bailey, Reid R Christensen, Isabel K. Eng, Mark D. Girgis, S. Carmichael, Clifford Y. Ko, Melinda Maggard‐Gibbons, Tara A. Russell · 发表于：Journal of the American College of Surgeons · 年份：2025 · DOI：10.1097/xcs.0000000000001613 · 被引用次数：1 · 研究领域：Intestinal and Peritoneal Adhesions、Hernia repair and management、Intraperitoneal and Appendiceal Malignancies

SUMMARY: Small bowel obstructions (SBOs) due to intra-peritoneal adhesive disease are a common sequela of abdominal surgery. While reducing adhesions is a frequent therapeutic goal, it remains unclear whether adhesion reduction translates to decreased adhesive SBO rates. This study aimed to compare adhesive SBO rates following surgery with and without intra-peritoneal adhesion prophylactic agents use in adults. A systematic search was conducted in PubMed, Embase, Cochrane, and Web of Science for English studies published between January 1, 2000, and February 15, 2024, reporting on SBOs following intra-peritoneal adhesion prophylactic agent application. Studies without primary data, non-clinical studies, reviews, commentaries, and editorials were excluded. A total of 9,262 unique titles were identified, of which ultimately 31 studies met inclusion criteria. Twelve randomized controlled trials and 14 observational studies were included in meta-analyses. Five studies were unable to be included in meta-analyses. Outcomes included SBO rates occurring less than (early) and greater than (late) 30 days post-operatively, and adverse event rates (anastomotic leak, intra-abdominal abscess, and wound infection). Five intra-peritoneal adhesion prophylactic agents were identified. Use of prophylactic agents reduced both early (1.1% vs 2.9%, odds ratio [OR] 0.40; 95% CI [0.21, 0.74]) and late (7.6% vs 9.9%, OR 0.76; 95% CI [0.60, 0.95]) SBO rates. On sub-analysis, Guardix®, but not Seprafil...