Application of biomaterials for the prevention of postoperative adhesion

Postoperative adhesions (POA) are common surgical complications that can lead to severe consequences, including pain and impaired tissue/organ function. The pathogenesis of these complications involves the synergistic effects of surgical trauma, inflammatory responses, fibroblast proliferation, collagen deposition, and fibrinolytic imbalance. Biomaterials have become a research hotspot in anti-adhesion studies owing to their biocompatibility, degradability, and design flexibility. Anti-adhesion materials function through multiple mechanisms, including physical barrier isolation, inflammatory modulation, fibrinolytic promotion, and inhibition of fibrotic pathways. Substantial progress has been achieved in multi-organ applications, including cardiac, abdominal, and tendon repair surgeries. In this review, we discuss the mechanism of postoperative adhesion and systematically and comprehensively introduce the pathological mechanism of postoperative adhesion formation, anti-postoperative adhesion mechanism, and the role of different types of hydrogels in anti-postoperative adhesion. Additionally, we introduce the latest progress in the application of biomaterials in different organ systems to prevent the development of POA. • Active microenvironment modulation for anti-adhesion. • Design of composite postoperative anti-adhesion hydrogels. • Cross-organ exploration of anti-adhesion design strategies.