title: Efficacy of auto-crosslinked hyaluronan gel for adhesion prevention in laparoscopy and hysteroscopy: a systematic review and meta-analysis of randomized controlled trials.
abstract: Prevention of postoperative adhesions is a clinical need. We undertook a systematic review to explore the available clinical evidence of the efficacy of auto-crosslinked hyaluronan gel for postoperative adhesion prevention following endoscopic gynecological surgery. An electronic database search of MEDLINE, Cochrane Database of Systematic Reviews and EMBASE, and a comprehensive hand-search of reference lists of published and review articles were performed. No language restrictions were applied. Randomized controlled trials (RCTs) on the use of auto-crosslinked hyaluronan gel for the prevention of postoperative adhesions in gynecological surgery were included in the meta-analysis if they reported outcomes as evaluated at a blind second-look assessment. Three authors independently selected studies and extracted data on study characteristics, quality and accuracy. The Jadad scoring system was used for validity assessment. Meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The outcome was the incidence of postoperative adhesions based on a binary response (present or not present). Only five RCTs were eligible for inclusion in the meta-analysis. The incidence of postoperative adhesions in patients who received auto-crosslinked hyaluronan gel was significantly lower than in patients who underwent standard surgery only. The gel prevented both intraperitoneal adhesions after laparoscopic myomectomy (OR 0.248, 95% CI 0.098, 0.628) and intrauterine adhesions after hysteroscopic surgery (OR 0.408, 95% CI 0.217, 0.766). Further RCTs are needed to assess the efficacy of auto-crosslinked hyaluronan gel in women undergoing different laparoscopic intra-abdominal surgical procedures.
authors.affiliation: Division of Gynaecology, Obstetrics and Pathophysiology of Human Reproduction, Department of Surgery, Maternal-Fetal Medicine and Imaging, University of Cagliari, 09124 Cagliari, Italy. gineca.vmais@tiscali.it
authors.forename: Valerio
authors.initials: V
authors.lastname: Mais
authors.forename: Maria G
authors.initials: MG
authors.lastname: Cirronis
authors.forename: Michele
authors.initials: M
authors.lastname: Peiretti
authors.forename: Giuliano
authors.initials: G
authors.lastname: Ferrucci
authors.forename: Ester
authors.initials: E
authors.lastname: Cossu
authors.forename: Gian B
authors.initials: GB
authors.lastname: Melis
mesh_terms: D005260:Female; D005782:Gels; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D015907:Hysteroscopy / Q000009:adverse effects*; D010535:Laparoscopy / Q000009:adverse effects*; D016032:Randomized Controlled Trials as Topic; D000267:Tissue Adhesions / Q000517:prevention & control*
chemical_list: D005782:Gels; D006820:Hyaluronic Acid