Background <p>Chronic pain resulting from postoperative adhesions represents a significant clinical concern due to its substantial impact on patient quality of life; however, optimal therapeutic management remains contentious. This systematic review and meta-analysis aimed to evaluate the efficacy of laparoscopic adhesiolysis in alleviating chronic pain attributable to postoperative adhesions, and to assess the influence of adhesion barriers on treatment outcomes.</p> Methods <p>A comprehensive systematic review was conducted by searching PubMed, Embase, and Web of Science from database inception through August 2025. Studies reporting pain improvement as the primary outcome, along with safety outcomes (including complication incidence and mortality), were eligible for inclusion. Pooled estimates were calculated using a random-effects model, and heterogeneity was quantified employing the I² statistic..</p> Results <p>A total of 30 studies involving 1,450 patients were included in the systematic review.</p> <p>In 27 single-arm observational studies (<i>n</i> = 1,150), laparoscopic adhesiolysis was associated with a pooled pain improvement rate of 67.3% (95% CI 57.5–76.2%), with substantial heterogeneity (I² = 91%). In contrast, pooled analysis of four randomized controlled trials (<i>n</i> = 271) demonstrated no statistically significant difference in pain improvement between laparoscopic adhesiolysis and diagnostic laparoscopy alone (38.9% vs 36.2%; risk ratio 1.05, 95% CI 0.61–1.83).</p> Conclusion <p>Although observational studies report relatively high rates of pain improvement, these findings should be interpreted as descriptive and hypothesis-generating. The highest level of available evidence from randomized controlled trials does not demonstrate a clinically meaningful benefit of laparoscopic adhesiolysis over diagnostic laparoscopy alone.</p> Trial registration <p>PROSPERO CRD42023478049.</p>