title: Evaluation of adhesions after laparoscopic myomectomy using the Harmonic Ace and the auto-crosslinked hyaluronan gel vs Ringer's lactate solution.
abstract: OBJECTIVE
  To evaluate the efficacy of a crosslinked hyaluronic acid (HA) for the prevention of postsurgical adhesions after laparoscopic myomectomy using the Harmonic Ace.
  
  
  METHODS
  Women 23-42 years of age who wished to conceive underwent laparoscopic myomectomy. As adhesion preventing agents, crosslinked HA gel was applied on the myometrial scar at the end of the surgery in Group A, whereas in Group B a Ringer's lactate solution was used in a prospective, observational study. Second-look mini-laparoscopy was performed 45-60 days after surgery and the adhesions were assessed according to a site-specific modified scoring.
  
  
  RESULTS
  The incidence of postoperative adhesions was the same in both groups, but anatomically significant adhesions and site-specific modified score was significantly reduced in Group A compared to Group B control group (31.8% vs 54.6% and 1.05 +/- 1 vs 2.27 +/- 2.5, respectively).
  
  
  CONCLUSIONS
  The use of auto-cross-linked HA gel confirms a protection on adhesion formation on myometrial wounds, although the degree of this effect appears to be weak. The absence of adnexa adhesions using the HA and a different uterine incision appear remarkable, although a larger number of patients is required to confirm the present findings.
authors: Department of Women's and Children's Health, Obstetrics and Gynecology Clinic, University of Padua, Padua, Italy. pietro.litta@unipd.it
authors: P
authors: P
authors: Litta
authors: N
authors: N
authors: Pluchino
authors: L
authors: L
authors: Freschi
authors: S
authors: S
authors: Borgato
authors: S
authors: S
authors: Angioni
mesh_terms: D000328:Adult; D003432:Cross-Linking Reagents; D005260:Female; D005782:Gels; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007552:Isotonic Solutions; D010535:Laparoscopy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D011183:Postoperative Complications; D011446:Prospective Studies; D000077325:Ringer's Lactate; D024162:Second-Look Surgery; D000267:Tissue Adhesions / Q000453:epidemiology / Q000517:prevention & control*; D059708:Ultrasonic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D063186:Uterine Myomectomy / Q000009:adverse effects*
chemical_list: D003432:Cross-Linking Reagents; D005782:Gels; D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D006820:Hyaluronic Acid