Efficacy of Antiadhesion Barriers on Swallowing Function After Thyroidectomy: A Systematic Review and Meta-analysis

Thyroidectomy is frequently complicated by postoperative swallowing dysfunction, often attributed to peritracheal adhesions and fibrosis. Antiadhesion barriers are increasingly utilized in an attempt to mitigate these sequelae; yet their efficacy in improving patient-centered functional outcomes remains uncertain and inadequately synthesized.

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review and meta-analysis of randomized controlled trials from PubMed, Scopus, and Cochrane Central Register of Controlled Trials (up to July 2025) was conducted. Outcomes included swallowing, voice outcomes, and safety. Swallowing outcomes were collected by patient-reported scales, such as the Swallowing Impairment Score, visual analog scale swallowing scores, and Likert-type measures of swallowing. Voice outcomes were assessed by using the Voice Handicap Index-10, while safety outcomes were measured through documented postoperative complications, including recurrent laryngeal nerve injury, seroma, infection, and postoperative drainage volume. Data were standardized and pooled using random-effects models, and subgroup analyses were performed by barrier type and follow-up duration.

A total of 557 patients in seven randomized controlled trials were included. Pooled analysis showed no significant overall effect of barriers on swallowing function (standardized mean difference (SMD) = 0.00, 95% confidence interval [CI]: -0.45 to 0.45; P = 0.99; I² = 90%). Sensitivity analysis, excluding an outlier study, substantially reduced heterogeneity (I² = 46%) but confirmed a nonsignificant effect (SMD = -0.12, 95% CI: -0.42 to 0.18; P = 0.43). Subgroup analysis revealed a short-term benefit at 1-3 mo (SMD = -0.49, 95% CI: -0.96 to -0.02; P = 0.04), which was absent in the long-term (≥3 mo: SMD = 0.09, 95% CI: -0.19 to 0.37; P = 0.52; test for subgroup differences P = 0.03). No barrier type demonstrated clear superiority.

Antiadhesion barriers may offer transient swallowing improvement without sustained benefit. Safety is acceptable, but higher-quality evidence is needed before routine use can be recommended.