Efficacy of Anti‐Adhesive Barriers on Outcomes Following Pediatric Abdominal Surgery: A Systematic Review and Meta‐Analysis

Background and Aims The efficacy of anti‐adhesive barriers in preventing clinically significant adhesional small bowel obstruction (ASBO) in the pediatric population is poorly defined. This review seeks to evaluate the utility of anti‐adhesive barriers in pediatric populations undergoing abdominopelvic surgery. Methods A literature search was performed on Embase, Medline, Cochrane Centra,l and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) on 20 August 2024. Our main outcome measures included ASBO, total complications, return to theater and surgical site infection. Results A total of three studies were included in this review; however, two studies were published from the same group and institution. Separate analyses were performed due to the potential for overlapping cohorts. Analysis of two studies involving 912 patients comparing anti‐adhesive barriers (n = 462) to control (n = 440) suggested that anti‐adhesive barriers reduced the risk of ASBO compared with control (OR 0.39, 95% CI 0.19–0.84, p = 0.02). There is insufficient evidence to suggest that anti‐adhesive barriers were superior to control in reducing overall postoperative complications (OR 0.81, 95% CI 0.41–1.58, p = 0.63), surgical site infection (OR 0.95, 95% CI 0.35–2.57, p = 0.09). Conclusion Anti‐adhesive barriers may have a role in the prevention of ASBO in pediatric populations undergoing open abdominopelvic surgery. However, this occurs on the background of moderate to high risk of bias, small sample size, and high clinical heterogeneity with poor control for confounders. Further prospective research is required to further validate these effects.