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  • Writer's pictureHannah Hunt

Efficacy of Adhesion Barrier Powders: Insights from recent research

surgeon looking at bottle of 4df adhesion barrier

Adhesion formation is a prevalent issue which can lead to numerous complications, such as chronic pain, infertility, and bowel obstruction. With cost considerations at the forefront for the NHS, products which claim to have 2-in-1 functionality for adhesion prevention and haemostasis are of both great interest and scepticism.

Two recent studies provide insight into the efficacy of traditional and novel modified starch haemostats in preventing post-operative adhesions. These compared 4DryField® PH, Arista™ AH, HaemoCer™ PLUS, and StarSil® for their capabilities in reducing the extent and severity of adhesions using the Optimised Peritoneal Adhesion Model (OPAM).

Study 1: 4DryField® PH vs. Arista™ AH

Published in the International Journal of Medical Sciences in 2019.

  • 4DryField® PH: This was applied as a powder and transformed into a gel with saline solution. The results showed a statistically significant reduction in adhesion formation, both macroscopically and histopathologically when compared with Arista and controls.

  • Arista™ AH: did not demonstrate a significant reduction in adhesion formation when used in the same manner.

Conclusion: Only 4DryField® PH but not Arista™ AH was effective in reducing postoperative adhesion formation when both devices were applied in the same manner. Modified starch-based powder hemostats are not naturally capable to reduce the formation of peritoneal adhesions. Instead, the effectiveness depends on the specific properties of the individual product 

table outlining results of adhesion barrier study

Study 2: 4DryField® PH vs. HaemoCer™ PLUS and StarSil®

Published in the International Journal of Medical Sciences in 2024.

Building on the previous research, this study expanded the scope to include HaemoCer™ PLUS and StarSil®, both newly certified for adhesion prevention.

  • 4DryField® PH: Consistent with earlier findings, this product significantly prevented adhesion formation in the OPAM model, reinforcing its effectiveness as an anti-adhesive agent.

  • HaemoCer™ PLUS and StarSil®: Neither product achieved a statistically significant reduction in adhesion formation compared to controls. This outcome highlights that certification alone does not guarantee clinical effectiveness​​.

Conclusion: Only 4DryField® PH but neither HaemoCer™ PLUS nor StarSil® were capable to effectively prevent adhesion formation. These results corroborate the assumption that starch-based hemostats do not generally have the capability to act as effective adhesion prevention devices

table outlining results of adhesion barrier study

Implications for Surgical Practice

These studies underscore the importance of selecting proven products for adhesion prevention in surgical settings. The evidence suggests that:

  1. 4DryField® PH is a reliable starch-based haemostat for with high efficacy in adhesion prevention.

  2. Arista™ AH, HaemoCer™ PLUS, and StarSil® do not offer the same level of efficacy in adhesion prevention.

In contrast to other starch-based haemostats which are typically reabsorbed after 2 days, 4DryField PH is reabsorbed after 7 days, meaning it remains in the body as a barrier until the mesothelial tissue has healed and therefore is able to more effectively prevent adhesion formation. When considering cost implications, it's crucial to prioritise products with demonstrated effectiveness as well as dual functionality. Investing in proven adhesion prevention agents can lead to better patient outcomes, reduced postoperative complications, reduced subsequent ahdesiolysis procedures, and lower long-term healthcare costs.

4DryField PH is available to trial free of charge.

To arrange a free trial in your hospital with in-person support from a product specialist, contact AGHealth here.


  1. Adhesion Prevention in Abdominal Surgery: Comparing 4DryField® PH and Arista™ AH in the OPAM Rat Model, Int. J. Med. Sci. Poehnert et al. 2019; Vol. 16.

  2. Comparison of adhesion prevention capabilities of the modified starch powder-based medical devices 4DryField® PH, HaemoCer™ PLUS and StarSil® in the Optimized Peritoneal Adhesion Model, Int. J. Med. Sci. Poehnert et al. 2024; 21(3): 424-430.


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