Clinical Impact of Anti-adhesive Materials in Preventing Postoperative Small Bowel Obstruction After Gastrectomy for Gastric Cancer: A Multicenter Observational Study Including 2,077 Patients

Background/Aim: This study aimed to evaluate the preventive effect of anti-adhesive materials (AAMs) on the incidence of small bowel obstruction (SBO) and to investigate the risk factors for SBO within five years after gastrectomy for gastric cancer. Patients and Methods: This multicenter cohort study included 2,077 patients with gastric cancer who underwent total gastrectomy (TG) or distal gastrectomy (DG). Patients were followed for five years after surgery. Clinical characteristics associated with AAM use and risk factors for postoperative SBO were analyzed. Results: Among the included patients, 959 received AAMs and 1,118 did not. Intraoperative blood loss and operative time were greater in the AAM group. Open surgery and drain placement were more frequently performed in the AAM group. SBO occurred in 4.8% of patients in the AAM group and 4.7% in the non-AAM group. A higher incidence of postoperative intra-abdominal abscess was observed in the AAM group than in the non-AAM group (6.6% vs. 3.7%, p=0.003). Multivariate analysis identified TG [odds ratio (OR)=1.81, p=0.004], postoperative ileus (OR=2.61, p=0.043), and reoperation (OR=4.88, p<0.001) as independent risk factors for SBO within five years after gastrectomy. Conclusion: The use of AAMs did not demonstrate a significant preventive effect on postoperative SBO after radical gastrectomy for gastric cancer and may be associated with an increased risk of postoperative intra-abdominal abscess.