Engineering Functional Biomaterials for the Effective Prevention of Postoperative Adhesion: Strategies, Mechanisms, and Future Perspectives

Abstract Postoperative adhesions remain a significant clinical challenge in patients undergoing various surgical procedures, as they can lead to severe complications, accelerated disease progression, and increased mortality risk. Furthermore, these adhesions impose a substantial economic burden due to prolonged hospital stays, extended operative times, and delayed recovery. Despite considerable advances over the past two decades in understanding the mechanisms underlying adhesion formation, many aspects of their etiology and pathogenesis remain poorly elucidated. Consequently, the development of effective preventive strategies and the application of tissue engineering approaches to inhibit postoperative tissue adhesions have proven difficult. Although several translationally researched anti-adhesion products (polymer solutions and solid films) have attained moderate clinical success, currently available products suffer from inherent drawbacks including inadequate tissue retention, leakage, poor conformability to irregular wounds, and cumbersome operation, which substantially restrict their therapeutic efficacy in clinical practice. It is urgent to engineer novel biomaterials that integrate facile administration, long-term local retention, and excellent conformability to complex wound surfaces for postoperative anti-adhesion applications. This review offers a comprehensive overview of the mechanisms involved in postoperative tissue adhesions, current intervention strategies, and existing anti-adhesion barriers, including polysaccharide- and biodegradable polymer-based films and hydrogels. Additionally, it examines the mechanisms of action and limitations of these therapeutic biomaterials, thereby providing a solid theoretical foundation and technical guidance for the design of more effective anti-adhesion biomaterials.