Postoperative peritoneal adhesions are common sequelae of abdominal surgery. Acute as well as chronic complications, including bowel obstruction, abdominal pain and infertility can arise from adhesion formation. So far, the only reliable treatment is surgical adhesiolysis, which in turn is accompanied by an increased risk of adhesion recurrence. Despite significant progress in modern perioperative medicine, only limited prophylactic approaches are available and atraumatic surgery is still the most important factor.Current research concepts focus on two major antiadhesion strategies: firstly, the intraoperative placement of mechanical barriers and secondly novel immunomodulation concepts. Clinical data about the use of antiadhesive barriers show a heterogeneous outcome. Promising data have arisen from the immunomodulatory approaches and now require a step-up development from experimental to clinical trial level.The present review gives a short overview about the current research on the pathophysiology and prevention of peritoneal adhesions. The promising data are encouraging and require realization of carefully designed prospective clinical trials.