Open research questions in Intestinal and Peritoneal Adhesions

What the literature leaves open

• There is a lack of clinical evidence for the use of natural products and biomaterials in preventing post-surgical adhesions. Bioavailability, safety, and standardisation are challenges that need to be addressed.

  Natural Products and Biomaterial Strategies for Preventing Post-Surgical Adhesions: Emerging Anti-Fibrotic Agents and Mechanistic Insights · 2026 · DOI

• The mechanism of anastomotic leakage development is not sufficiently explained. The current classification of leakage is retrospective and descriptive, offering limited clinical utility. There is a lack of a marker for indication of CT scan and clear indications for a management protocol.

  Advancing early diagnosis of colorectal anastomotic leakage using drain fluid biochemical analysis · 2026 · DOI

• High risk of stoma formation and postoperative complications with emergency resection. Limited availability of alternative strategies to traditional emergency resection. Technical challenges associated with SEMS placement.

  Colonic Stenting as a Bridge to Surgery Versus Emergency Resection in Left-Sided Malignant Large Bowel Obstruction: A Systematic Review · 2026 · DOI

• The high mortality rates associated with peritonitis. The lack of effective methods for the treatment of peritonitis. The need for accurate diagnosis and assessment of the severity of endotoxicosis.

  Methods of surgical correction of endotoxic shock in patients with diffuse peritonitis · 2026 · DOI

• Diagnosis of spontaneous interparietal posterior rectus sheath hernias can be difficult due to the lack of an obvious external bulge. Treatment of these hernias may require operative exploration.

  Spontaneous interparietal posterior rectus sheath hernia presenting as small bowel obstruction in a virgin abdomen: a case report · 2026 · DOI

• The formation of phytobezoars can lead to serious gastrointestinal complications. The diagnosis of phytobezoars can be challenging due to the lack of specific symptoms. The treatment of phytobezoars can be difficult due to the risk of complications.

  Factors associated with gastrointestinal obstruction in phytobezoar patients: an emergency ultrasound study · 2026 · DOI

• Bezoar-induced small bowel obstruction is an uncommon but important consideration in patients with prior Roux-en-Y gastric bypass. There is a need for increased awareness and understanding of this condition.

  Bezoar-Induced Small Bowel Obstruction in a Patient With a Remote History of Gastric Bypass: A Case Report · 2026 · DOI

• The lack of understanding of the mecanismos fisiopatológicos of the obstrucción intestinal por adherencias posoperatorias. The necessity of developing estrategias preventivas and terapéuticas efectivas for the obstrucción intestinal por adherencias posoperatorias.

  Fisiopatología de la obstrucción intestinal por adherencias posoperatorias en humanos: Una revisión integrativa con perspectiva traslacional · 2026 · DOI

• Chronic constipation is a heterogeneous condition with distinct pathophysiological mechanisms. Clinical evaluation alone is insufficient to identify candidates for surgical treatment. There is a lack of standardized selection criteria for surgical treatment.

  Surgical treatment of chronic constipation: who should be referred for surgery? · 2026 · DOI

• There is a lack of standardized selection criteria for surgical treatment. There is limited evidence on the use of diverting loop ileostomy as a diagnostic tool. There is a need for further research on the outcomes of surgical treatment for chronic constipation.

  Surgical treatment of chronic constipation: who should be referred for surgery? · 2026 · DOI

• Multiorgan failure remains a primary driver of mortality - The lack of easily quantifiable biomarkers for the gut

  The Gut Pathobiome: A New Frontier in the Management of the Critically Ill · 2026 · DOI

• There is a lack of comprehensive PROMs that evaluate both symptoms and quality of life in IPAD patients. Existing PROMs have limitations in evaluating patient experiences. There is a need for further research on IPAD-related PROMs.

  Patient reported outcome measures in intra-peritoneal adhesive disease: a scoping review · 2026 · DOI

• The primary limitation of this study is the overlapping symptomatology between IPAD and various other disease states. Peritoneal adhesions pose a challenge to researchers and clinicians as they are unpredictable where they will develop within the abdomen/pelvis and whether they will be clinically significant [3]. The inconsistency in clinical manifestations can make diagnosis of IPAD difficult and may have limited our ability to capture all the symptoms and quality of life subdomains which represent IPAD. Another potential limitation inherent to our scoping review methodology is the restriction of article types and exclusion of non-English studies. This was done to ensure we were able to comprehensively review and evaluate all studies in our search based on our inclusion and exclusion criteria.

  Patient reported outcome measures in intra-peritoneal adhesive disease: a scoping review · 2026 · DOI

• Clinical translation of natural product-based anti-adhesion therapies needs careful comparison with current commer- cial products like Seprafilm® and Hyalobarrier®. These products can work well in some surgical situations, but they have shown inconsistent results in clinical trials [98, 99]. Existing clinical barriers act primarily as passive physi- cal separators and do not modulate the molecular drivers of adhesion formation, including inflammation, oxidative stress, and fibroblast activation [17, 18]. In contrast, natural product-based systems are designed to incorporate bioactive compounds within biomaterial platforms, thereby offering the potential for combined physical separation and localized modulation of pathways implicated in adhesion pathogen- esis, including TGF-β, NF-κB, and reactive oxygen spe- cies. Preclinical studies on natural compounds are showing promising results. For example, curcumin-loaded polymeric 1 3Regenerative Engineering and Translational Medicine Fig. 3 Schematic diagram show- ing the ideal characteristics to be present in any natural product for the treatment of adhesions. Drawn with Biorender.com membranes, like PCL, SPC, and CUR films, outperformed Seprafilm in terms of anti-adhesion. Histology, immunohis- tochemistry, and gross examination all supported this [28]. Resveratrol has also been demonstrated to lower fibrosis by reducing the accumulation of extracellular matrix (ECM). Through the TGF-β/SMAD pathway, it alters profibrotic signalling and enhances ECM breakdown. These effects sup- port its potential as an anti-adhesion treatment [100]. Other candidates have also shown promising results. By restor- ing collagen balance, lowering cell death, and encourag- ing tissue regeneration, epigallocatechin-3-gallate (EGCG) showed antifibrotic and regenerative qualities when added to hyaluronic acid hydrogels. In preclinical models, quer- cetin-loaded nanofibers also reduced the intensity of adhe- sions [101, 102]. Despite the promising preclinical evidence supporting these anti-adhesive agents, limitations in their translation from animal models to human use are still present. Due to the differences in anatomy, immune responses, and fibrino- lytic activity, the use of animal models fails to fully replicate the clinical conditions seen in humans, and these transla- tional limitations are further extended when considering the variability in dosing, timing, and routes of administra- tion [5, 103]. From a pharmacological standpoint, natural drugs including curcumin and resveratrol usually exhibit lower bioavailability. This is due to their relatively poor solubility, rapid metabolism, and rapid elimination, which in turn reduces their action in vivo [104, 105]. Despite the biomaterial-based delivery systems, that include hydrogels and nanocarriers, that aim to enhance the localization and sustainment of these anti-adhesive agents, limitations still arise when looking into their biodegradability and long- term safety [59]. Moreover, the reliance on standardised, identical injury patterns seen in many experimental models does not effectively reflect the true nature of the complex post-operative surgical conditions commonly seen [106]. To date, clinical evidence for natural products in adhe- sion prevention is scarce. Limited human studies with vita- min E and curcumin have shown signals of benefit, but no large randomized controlled trials exist. This highlights a critical translational gap: while preclinical data are prom- ising, robust human trials are urgently required before natural product-based strategies can be considered viable alternatives to existing commercial barriers. Future stud- ies should concentrate on developing robust human-related models, standardising and reproducing formulations, and integrating with biomaterials on a large scale in order to fill these gaps. Overall, carefully planned randomised clinical trials are required. These trials should not only assess the incidence of adhesion but also look at patient-centred out- comes like fertility preservation, bowel obstruction, and the need for reoperation. The ideal characteristics of a natural product intended for adhesion prevention are illustrated in Fig. 3.

  Natural Products and Biomaterial Strategies for Preventing Post-Surgical Adhesions: Emerging Anti-Fibrotic Agents and Mechanistic Insights · 2026 · DOI

• The study had technical complications with measuring D-Lactate, which limited the analysis. The study suggests that further trials with larger numbers of patients are needed to verify the conclusions. The elevation of Calprotectin and Neopterin concentrations may be false positive in patients with other intra-abdominal complications.

  Advancing early diagnosis of colorectal anastomotic leakage using drain fluid biochemical analysis · 2026 · DOI

• Abstract The effectiveness of gastrointestinal bypass surgery for treating non-strangulated adhesive small bowel obstruction (ASBO) remains unclear.

  Gastrointestinal bypass surgery for non-strangulated adhesive small bowel obstruction · 2026 · DOI

• There is a lack of awareness of atypical etiologies of SBO in transplant recipients. There is a need for a systematic review of the literature on SBO in adult transplant patients.

  Unusual cause of small bowel obstruction in a liver transplant recipient: a case report and focused literature review · 2026 · DOI

• Further studies are needed to evaluate the long-term outcomes of SEMS compared with emergency resection. Studies should investigate the cost-effectiveness of SEMS in this patient population. Research should focus on improving the technical aspects of SEMS placement and reducing stent-related complications.

  Colonic Stenting as a Bridge to Surgery Versus Emergency Resection in Left-Sided Malignant Large Bowel Obstruction: A Systematic Review · 2026 · DOI

• The article's recommendation to avoid bowel preparation agents containing poorly absorbed carbohydrates may not be adequately supported by the cited evidence.

  Expression of Concern on “Colonic gas explosion during therapeutic colonoscopy with electrocautery” · 2026 · DOI

• There is a lack of studies investigating the difference in intestinal diameter measurements between right lateral and ventrodorsal abdominal radiographs in dogs. Prior studies have not established the reliability of small intestinal diameters as a parameter for differentiating mechanical obstruction from functional ileus.

  Projection-Dependent Variability of Intestinal Diameter Measurements Between Right Lateral and Ventrodorsal Abdominal Radiographs in Dogs · 2026 · DOI

• The lack of a definitive solution for the problem of peritonitis despite the introduction of new methods of treatment and the use of new antibiotics. The need for effective methods of surgical correction of endotoxic shock in patients with diffuse peritonitis.

  Methods of surgical correction of endotoxic shock in patients with diffuse peritonitis · 2026 · DOI

• The paper identifies a gap in the current situation in Slovakia regarding gastrointestinálna onkológia. The authors highlight the need for new treatment methods.

  Gastrointestinálna onkológia · 2026 · DOI

• The importance of correlating imaging findings with clinical presentation to guide appropriate management and avoid unnecessary invasive interventions is not always recognized.

  When Portal Venous Gas Is Not Catastrophic: Accidental Hydrogen Peroxide Ingestion Managed Conservatively · 2026 · DOI

• Further studies should focus on expanding the sample size and conducting multicentre investigations. Particular attention should be directed to dynamic monitoring of cytokine-haemostasis interactions in the perioperative period.

  IMMUNOBIOCHEMICAL CHARACTERISTICS OF ACUTE ADHESIVE INTESTINAL OBSTRUCTION · 2026 · DOI

• The pathogenetic mechanisms of AAIO have not been fully elucidated, particularly at the level of immunobiochemical markers.

  IMMUNOBIOCHEMICAL CHARACTERISTICS OF ACUTE ADHESIVE INTESTINAL OBSTRUCTION · 2026 · DOI

Most-cited papers in Intestinal and Peritoneal Adhesions

• Current Status and Surgical Technique for Restorative Proctocolectomy with Ileal Pouch Anal Anastomosis · Balkan Medical Journal · 2023 · 6 citations
• The Efficacy and Results of Medical Treatment in Postoperative Ileus · Nigerian Journal of Clinical Practice · 2023 · 6 citations
• Surgical colic caused by fibrous bands and adhesions in absence of previous abdominal surgery: 9 cases (2012–2019) · Equine Veterinary Education · 2021 · 5 citations
• Method of Prevention of Postoperative Peritoneal Adhesions · Northern Clinics of Istanbul · 2022 · 4 citations
• Postoperative ileus and possibilities of pharmacological intervention · Perspectives in Surgery · 2024 · 2 citations
• Peritoneal lactate concentration in Shetland ponies with nonstrangulating intestinal lesions: A case series · Equine Veterinary Education · 2025 · 2 citations
• Peritonealization in gynecology and obstetrics: Review of literature · Medicinski pregled · 2013 · 1 citations
• Diagnosis and management of intestinal obstruction during pregnancy · Romanian Medical Journal · 2022 · 1 citations
• Establishing the cut-offs of leaky gut syndrome diagnostic: where are we now? · Proceedings of the Latvian Academy of Sciences Section B Natural Exact and Applied Sciences · 2022 · 1 citations
• The use of coffee for the prevention of ileus following abdominal surgery: A review of the current evidence · Pelviperineology · 2022 · 1 citations

Most recent work

• Early outcomes of transverse perineal support in obstructed defecation syndrome with pathological perineal descent; a prospective cohort study · BMC Surgery · 2026
• A Biocompatible CMCHMA/F127DA Hydrogel with ROS-Scavenging Activity Prevents Postoperative Peritoneal Adhesions · ACS Omega · 2026
• Clinical Determinants and Operative Impact of Adhesions in Women Undergoing Laparoscopic Gynaecological Surgery: A Retrospective Analysis · Sri Lanka Journal of Medicine · 2026
• Nutrition Support for Children with Paediatric Intestinal Pseudo-Obstruction (PIPO) in the United Kingdom—An Explorative Survey by the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) · Nutrients · 2026
• Patient reported outcome measures in intra-peritoneal adhesive disease: a scoping review · Techniques in Coloproctology · 2026
• Natural Products and Biomaterial Strategies for Preventing Post-Surgical Adhesions: Emerging Anti-Fibrotic Agents and Mechanistic Insights · Regenerative Engineering and Translational Medicine · 2026
• Development and validation of an explainable machine learning model for predicting surgical intervention in pediatric intestinal obstruction · European Journal of Pediatrics · 2026
• Improving Quality of Life in Terminal Patients With Malignant Bowel Obstruction: A Feasible, Safe and Successful Interventional Radiological Technique · Canadian Association of Radiologists Journal · 2026
• Advancing early diagnosis of colorectal anastomotic leakage using drain fluid biochemical analysis · Scientific Reports · 2026
• Análise físico-química e cultura do líquido peritoneal de 15 equinos com abdômen agudo · REVISTA DELOS · 2026

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