Hyaluronic acid fluid agents for the prevention of adhesions after fertility-preserving gynecological surgery: a meta-analysis of randomized controlled trials.

OBJECTIVE: To investigate the role of hyaluronic acid-based fluid agents in the prevention of adhesions after fertility-preserving gynecological surgery.

DESIGN: Meta-analysis.

SETTING: The authors searched the Cochrane Menstrual Disorders and Subfertility Group Specialized Register of Controlled Trials, The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE for randomized controlled trials of hyaluronic acid fluid agents compared with no treatment or placebo.

PATIENT(S): Women undergoing fertility-preserving gynecological surgery.

INTERVENTION(S): Hyaluronic acid fluid agents.

MAIN OUTCOME MEASURE(S): [1] Prevalence and change in adhesion severity at second-look laparoscopy and [2] live birth rate.

RESULT(S): Four studies were included in the meta-analysis. The use of hyaluronic acid agents was associated with a decrease in the prevalence of adhesions at second-look laparoscopy (odds ratio, 0.31; 95% confidence interval, 0.19 to 0.51) and a lesser chance of deterioration of preexisting adhesions (odds ratio, 0.28; 95% confidence interval, 0.12 to 0.66). There was, however, no evidence for improvement in the prevalence of adhesions (odds ratio, 1.55; 95% confidence interval, 0.82 to 2.92).

CONCLUSION(S): There is evidence that hyaluronic acid agents may decrease the prevalence of adhesions and prevent the deterioration of preexisting adhesions. However, because of the limited number of studies available, this evidence should still be interpreted with caution.