RESULTS OF DIAGNOSIS AND TREATMENT OF ADHESIVE DISEASE OF ABDOMINAL ORGANS IN CHILDREN

Abstract

Background: Adhesive disease of the abdominal organs is an important late consequence of pediatric abdominal surgery and most commonly presents as adhesive
small-bowel obstruction. In children, the evidence base remains limited, heterogeneous, and less mature than that in adults, particularly with respect to diagnostic
pathways, duration of conservative treatment, timing of surgery, and the role of water-soluble contrast and minimally invasive adhesiolysis.
Objective: To systematically review the published literature on the diagnosis and treatment of postoperative adhesive disease in children and to perform an
exploratory meta-analysis of treatment outcomes where numerical data were sufficiently extractable.
Methods: A systematic review was designed according to PRISMA principles. Searches were planned for PubMed/MEDLINE, Embase, Scopus, Web of Science,
PsycINFO, Cochrane CENTRAL, and grey-literature sources, with a final search cutoff of 2026-03-09. Eligible studies included pediatric cohorts, comparative
observational studies, and interventional series evaluating diagnostic methods, conservative management, surgical treatment, recurrence, or prevention of
postoperative adhesive disease. Screening and data extraction were specified to be performed independently by two reviewers, with disagreement resolved by
third-reviewer adjudication. Random-effects meta-analysis was used for extractable outcomes.
Results: Fourteen studies were included in the qualitative synthesis, and five contributed numerical data to the exploratory meta-analysis of initial non-operative
management. Across the included literature, conservative treatment was feasible in selected children but showed marked inter-study variability. The pooled success
proportion for initial non-operative management was 53.4% (95% confidence interval, 43.7%-62.8%), with substantial heterogeneity (I²=69.9%). Evidence from
individual cohorts suggested that delayed surgery beyond 48 hours after failed observation may increase the risk of bowel resection, whereas infants and children
with fever, complete obstruction, or suspected strangulation were more likely to require operative treatment. Water-soluble contrast protocols appeared promising
for both diagnosis and management, although pediatric comparative evidence remained limited.
Conclusions: In children, postoperative adhesive disease should be managed using early risk stratification, carefully monitored and time-limited conservative
treatment in selected patients, and prompt surgery when deterioration or treatment failure occurs. Although water-soluble contrast pathways and minimally invasive
approaches appear beneficial in selected settings, the overall certainty of evidence remains low, and prospective multicenter pediatric studies are needed.