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This study demonstrates that bone marrow mesenchymal stem cells encapsulated in a silk hydrogel (BMSC@Gel) not only prevent tissue adhesion but also restores physiological functions in both mouse tissues and human\u2010derived organoids. BMSCs exert dual regulatory effects on the obstructed intestinal microenvironment. First, they preferentially differentiate into proliferating fibroblasts (FBs) expressing\n                    <jats:italic>Top2a<\/jats:italic>\n                    ,\n                    <jats:italic>Stmn1<\/jats:italic>\n                    , and\n                    <jats:italic>Spp1<\/jats:italic>\n                    rather than inflammatory FBs marked by\n                    <jats:italic>Adamdec1, Mmp3, and Igfbp3<\/jats:italic>\n                    . Second, BMSC\u2010derived exosomes suppress the inflammatory microenvironment, thereby maintaining intestinal homeostasis. Furthermore, BMSCs modulate fibroblast phenotypes and intracellular interactions and inhibit the TGF\u2010\u03b21\/Smad3 signaling pathway during fibrosis development, thereby reversing the onset of ASBO. Collectively, these findings highlight BMSC@Gel as a promising therapeutic strategy for the prevention of ASBO in clinical practice.\n                  <\/jats:p>","DOI":"10.1002\/advs.202513781","type":"journal-article","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T13:26:59Z","timestamp":1761658019000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Bone Marrow Mesenchymal Stem Cell Hydrogel\u2010Mediated Fibroblast Reprogramming Restores Intestinal Function in Adhesive Small Bowel Obstruction"],"prefix":"10.1002","volume":"13","author":[{"suffix":"*","given":"Lihong","family":"Zheng","sequence":"first","affiliation":[{"name":"Department of General Surgery (Emergency Surgery) Fujian Medical University Union Hospital  Fujian China"},{"name":"Department of General Surgery Fujian Medical University Union Hospital  Fujian 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