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| Hyaluronic acid agents may prevent adhesions after gynecological surgery |
Adhesion formation after fertility-preserving gynecological surgery may be decreased with the use of hyaluronic acid-based fluid agents, according to the results of a meta-analysis of available studies.
``Intraperitoneal adhesions are an important cause of postoperative intestinal obstruction, abdominal discomfort, and infertility,`` Dr. Mostafa Metwally, of the University of Sheffield, UK, and colleagues write in the May issue of Fertility and Sterility. ``Despite careful attention to minimize tissue trauma and ensure hemostasis, pelvic surgery is associated with both de novo adhesion formation and reformation.``
The researchers searched the Cochrane Menstrual Disorders and Subfertility Group Specialized Register of Controlled Trials, The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE and identified four randomized controlled trials of hyaluronic acid fluid agents compared with no treatment or placebo in women undergoing fertility-preserving gynecological surgery.
An association was observed between the use of hyaluronic acid agents and a decrease in the prevalence of adhesions at second-look laparoscopy (odds ratio [OR], 0.31). Patients treated with hyaluronic acid also had a decreased chance of deterioration of preexisting adhesions (OR, 0.28).
``As a result of the limited number of studies available, this evidence should be interpreted with caution,`` Dr. Metwally and colleagues stress.
``Ideally,`` they add, ``severity of adhesions should not be used as a surrogate marker for future fertility potential, and therefore, future studies should include live birth rate as a primary outcome measure and have adequate follow-up periods.`` |
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