[Interest of auto-cross-linked hyaluronic acid gel in the prevention of intrauterine adhesions after hysteroscopic surgery: A case-control study].
OBJECTIVE
To evaluate the efficacy of auto-cross-linked hyaluronic acid gel in the prevention of adhesions after operative hysteroscopy using a case-control study.


METHODS
Fifty-four patients with an intrauterine lesion (myoma, polyp, uterine septa and adhesions) undergoing hysteroscopic surgery were divided into two groups: group A (30 patients) with intrauterine application of hyaluronic acid gel at the end of the surgical procedure and group B, which was considered as control (24 patients). The rate of adhesion formation, the score and the adhesion severity were estimated for each group using American Fertility Society (AFS) classification, by diagnostic hysteroscopy two months after surgery. No other treatment was associated.


RESULTS
Age, weight, parity, hysterometry were comparable in the two groups. Surgery indications were polyp(s), myoma(s), uterine septa, and adhesions (11, 8, 1, and 10 patients in group A and 6, 6, 4, and 8 patients in group B, respectively). No difference was observed in intrauterine adhesion formation between the two groups (33.3% for group A and B; p = NS). The median adhesion scores using AFS were comparable in the two groups (1.30+/-2.35 vs 1.42+/-2.47; respectively, p = NS). The severity of the adhesions showed no significant difference between the two (70% stage I, mild adhesions; 20% stage II, moderate adhesions; 10% stage III, severe adhesions and 62.5% stage I; 25% stage II; 12.5% stage III in the group A and B, respectively). No adverse effect with the ACP gel was detected.


CONCLUSIONS
ACP gel does not reduce the incidence and the severity of intrauterine adhesions after hysteroscopic surgery.
Ducarme
G
G
Service de Chirurgie Gynécologique et d'Obstétrique, CHU Jean-Verdier (AP-HP), avenue du 14-Juillet, 93143 Bondy Cedex.
Davitian
C
C
Zarrouk
S
S
Uzan
M
M
Poncelet
C
C
D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D015907:Hysteroscopy / Q000009:adverse effects*; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control; D014591:Uterine Diseases / Q000209:etiology* / Q000517:prevention & control*
D006820:Hyaluronic Acid