Postoperative Adhesion Prevention in Surgical Procedures

Postoperative adhesions are fibrous bands that form between tissues and organs after surgical injury, often leading to chronic pain, organ dysfunction and complications in subsequent operations. The pathogenesis involves disruption of mesothelial or epithelial layers, fibrin deposition, reduced fibrinolysis and proliferation of tissue-resident fibroblasts, culminating in permanent scar formation. Prevention strategies have traditionally relied on mechanical barriers and pharmacological modulation of inflammation or coagulation. Recent advances, however, focus on multifunctional biomaterials that combine physical separation with controlled delivery of anti-adhesive or anti-inflammatory agents. Key challenges remain in achieving durable coverage of irregular wound surfaces, maintaining biocompatibility, and selectively targeting early cellular events without impeding normal healing. Given the global burden of adhesion-related morbidity and healthcare costs, innovative approaches that integrate insights into cellular mechanisms with advanced material design hold considerable promise for improving surgical outcomes.

Research from Nature Portfolio

Recent studies have deepened mechanistic understanding and introduced novel barrier materials. A superlubricated nano-skin grown in situ on electrospun nanofibres provides a continuous, low-friction coating that outperforms standard anti-adhesive membranes in rat tendon and abdominal adhesion models, while offering scalability and cost advantages. Investigations of mesothelial dynamics uncovered that calcium-dependent membrane protrusions from peritoneal cells form the initial tethering events; targeting these protrusions through cytoskeletal or calcium-signalling inhibitors applied during surgery abolishes adhesion formation in preclinical settings. In cardiothoracic surgery, a catechol-functionalised oxime hydrogel has been developed to adhere robustly to epicardial surfaces. This three-component polyethylene glycol network resists cellular attachment, exhibits controlled degradation and minimal swelling, and significantly reduces pericardial adhesions in both rodent and pilot porcine models, indicating its potential for reoperative procedures.

Postoperative Adhesion Prevention in Surgical Procedures publication trend

The graph below shows the total number of articles in postoperative adhesion prevention in surgical procedures across all publications each year (not limited to Nature Index journals).

Technical terms

Postoperative adhesion: Fibrous band formed between tissues or organs after surgery.

Barrier membrane: Physical layer applied to wounded surfaces to prevent tissue apposition.

Hydrogel: Water-rich polymer network used as a temporary tissue barrier.

Mesothelial cell: Surface-lining epithelial cell whose damage initiates adhesion.

Fibrinolysis: Enzymatic process that degrades fibrin clots, limiting early adhesion scaffolds.

Coefficient of friction: Quantitative measure of resistance between sliding surfaces in anti-adhesive materials.

References

1. Prevention strategies of postoperative adhesion in soft tissues by applying biomaterials: Based on the mechanisms of occurrence and development of adhesions. Bioactive Materials (2023).
2. Multifunctional Oxidized Dextran–Metformin as a Tissue‐Adhesive Hydrogel to Prevent Postoperative Peritoneal Adhesions in Patients with Metabolic Syndrome. Advanced Science (2023).
3. In-situ growth of robust superlubricated nano-skin on electrospun nanofibers for post-operative adhesion prevention. Nature Communications (2022).
4. Prevention of Post-Operative Adhesions: A Comprehensive Review of Present and Emerging Strategies. Biomolecules (2021).
5. Post-Operative Adhesions: A Comprehensive Review of Mechanisms. Biomedicines (2021).
6. Post-surgical adhesions are triggered by calcium-dependent membrane bridges between mesothelial surfaces. Nature Communications (2020).
7. Preventing post-surgical cardiac adhesions with a catechol-functionalized oxime hydrogel. Nature Communications (2021).