title: Prevention of intrauterine post-surgical adhesions in hysteroscopy. A systematic review.
abstract: OBJECTIVE
  The purpose of the present review is to provide a survey of the various measures of preventing adhesions used in hysteroscopic surgery.
  
  
  METHODS
  A systematic computerized literature search was conducted to provide a survey of the various measures used in hysteroscopic surgery to prevent adhesions. Finally, 29 studies were included in the analysis, showing a wide variety of methods and agents advocated in international literature. They are explained in various sections, based on the IUA prevention approach adopted (surgical technique, early second-look hysteroscopy, barrier method, pharmacological therapy).
  
  
  RESULTS
  The results of our review show that (i) use of surgical techniques which reduce the use of electrosurgery should be preferred whenever possible (Level of evidence: 4); (ii) an early second-look hysteroscopy would appear to be an effective preventive, as well as therapeutic, strategy regarding IUA but studies on the topic are too few for relevant evidence; (iii) barriers methods are the most widely used and, among these, gel barriers have been proven to have a significant clinical effect on IUA prevention, because of higher adhesiveness and prolonged residence time on the injured surface (Level of evidence: 1b); (iv) the role of hormonal and antibiotic therapy in the prevention of post-operative IUA is difficult to evaluate as it has been used in association with other prevention strategies in most studies included in our review.
  
  
  CONCLUSIONS
  Robust and high quality randomized trials to assess the effectiveness of different anti-adhesion therapies are still needed before one or more of these strategies may be strongly recommended for improving clinical outcomes in women treated by operative hysteroscopy.
authors.affiliation: Department of Public Health, University of Naples "Federico II", Naples, Italy. Electronic address: cdispie@tin.it.
authors.forename: Attilio
authors.initials: A
authors.lastname: Di Spiezio Sardo
authors.affiliation: Department of Sciences for Health Promotion and Mother and Child Care, Obstetrics and Gynecology Unit, University of Palermo, Palermo, Italy.
authors.forename: Gloria
authors.initials: G
authors.lastname: Calagna
authors.affiliation: Department of Public Health, University of Naples "Federico II", Naples, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Scognamiglio
authors.affiliation: M.E.R.I.T. Centre, Bradford Royal Infirmary, Bradford, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: O'Donovan
authors.affiliation: Leuven Institute for Fertility and Embryology (LIFE), Leuven, Belgium.
authors.forename: Rudi
authors.initials: R
authors.lastname: Campo
authors.affiliation: Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, School of Medicine and Health Sciences, Medical University of Oldenburg, Oldenburg, Germany.
authors.forename: Rudy L
authors.initials: RL
authors.lastname: De Wilde
mesh_terms: D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects* / Q000639:trends; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control*; D014599:Uterus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery
keywords: Hysteroscopy; Intrauterine adhesion; Prevention