Comparison of 4DryField PH vs. seprafilm in reducing incidence of adhesion and preventing ASBO following abdominopelvic surgery: a systematic review

Background Adhesions form between tissue surfaces due to inflammation and trauma to tissue. Adhesions are a common postoperative complication of abdominopelvic surgery, often leading to chronic pain, adhesive small bowel obstruction, and increased healthcare costs. Anti-adhesive agents such as Seprafilm and 4DryField PH are employed to mitigate these risks, but direct comparisons between these barriers are lacking, creating a need to evaluate their relative efficacy. This systematic review aims to compare the efficacy of 4DryField PH and Seprafilm in preventing postoperative adhesion formation and associated complications such as ASBO in patients undergoing abdominopelvic surgery. Methods A search of PubMed, Scopus, Cochrane Library, Embase, and trial registries identified 7 studies, including RCTs and cohort studies. Inclusion criteria were studies involving patients aged 18 and above who underwent abdominopelvic surgery and received either 4DryField PH or Seprafilm. Studies that included patients with extensive pre-existing abdominal conditions and malignancies were excluded. Data was extracted on adhesion incidence, severity, extent, chronic pain, and ASBO. Results 4DryField PH consistently reduced adhesion burden in second-look studies and showed no recurrent ASBO in one cohort. Seprafilm demonstrated modest benefit in one colorectal study but not in another. Due to non-overlapping populations, direct comparison was not possible. Exploratory trends favoured both agents over no barrier. Conclusion Current evidence suggests that 4DryField PH may reduce adhesion burden in settings where second-look laparoscopy is performed, while Seprafilm may offer modest clinical benefit in selected colorectal surgery contexts. Because no head-to-head trials exist and the study populations differ, these findings remain hypothesis-generating. Further multicentre trials with standardised outcomes are needed to define their comparative roles.