Fluid and pharmacological agents for adhesion prevention after gynaecological surgery

Ahmad, Gaity; Mackie, Fiona L.; Iles, David; O’Flynn, Helena; Dias, Sofia; Metwally, Mostafa; Watson, Andrew

doi:10.1002/14651858.cd001298.pub4

Cited by 39 publications

(47 citation statements)

References 49 publications

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“…The included studies used 3 different types of hyaluronan, only 1 of which is still commercially available. A recent review that evaluated fluid and pharmacological agents for the prevention of adhesions yielded results similar to those seen in our meta-analysis [14]. That review evaluated interventions involving gels of steroids, noxytioline, heparin, and promethazine, whereas our analysis focused on hyaluronic acid and included additional clinical trials, including the newest one published in 2017.…”

Section: Discussionsupporting

confidence: 60%

Efficacy and Safety of Hyaluronic Acid Gel for the Prevention of Intrauterine Adhesion: A Meta-Analysis of Randomized Clinical Trials

Liu

et al. 2018

Gynecol Obstet Invest

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Background: The aim of this study is to assess the clinical effectiveness and safety of hyaluronic acid gel for the prevention of postoperative intrauterine adhesions (IUAs). Methods: PubMed, Cochrane Library, Embase and ClinicalTrials.gov databases were searched for randomized controlled trials. Results: Six RCTs with a total of 564 patients met the inclusion criteria. The meta-analysis showed that, compared to no other treatment method, hyaluronic acid gel significantly reduced the rate of any IUA (risk ratio [RR] 0.68; 95% CI 0.53–0.86; p = 0.03; I² = 64%) and adhesion score (standard mean difference = –2.90; 95% CI –4.61 to –1.49; p < 0.00001; I² = 98%) following intraperitoneal or intrauterine surgery. Treatment lowered the rate of IUAs classified as moderate (RR 0.26; 95% CI 0.13–0.52; p = 0.13; I² = 0%), but not those deemed mild (RR 0.86; 95% CI 0.62–1.21; p = 0.39; I² = 3%) or severe (RR 0.33; 95% CI 0.03–3.09; p = 0.33; I² = 0). Compliance with hyaluronic acid gel treatment was low. Conclusion: Hyaluronic acid gel can prevent IUAs, particularly those with moderate severity and a lower adhesion score.

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Section: Discussionsupporting

confidence: 60%

Efficacy and Safety of Hyaluronic Acid Gel for the Prevention of Intrauterine Adhesion: A Meta-Analysis of Randomized Clinical Trials

Liu

et al. 2018

Gynecol Obstet Invest

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“…Several studies have investigated the anti-adhesive effect and mechanism of NOCC, but few have combined the results of gross and pathological examinations (Ahmad et al, 2014). Therefore, we performed the present study to investigate the effects of NOCC application in both situations.…”

Section: Discussionmentioning

confidence: 99%

Use of N,O-carboxymethyl chitosan to prevent postsurgical adhesions in a rabbit double uterine horn model: a randomized controlled design

Ren

Zhao

Zhu

2016

Sci. China Life Sci.

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In previous studies, N,O-carboxymethyl chitosan has been shown to decrease the incidence and intensity of abdominal adhesions. In the present study, adhesions were induced in 220 rabbits using a double uterine horn model. Rabbits were randomized to receive an operation only or an operation+medical chitosan intraperitoneally. Twenty-two rabbits from each group were euthanized at one of five different times (Day 3, 7, 14, 28, or 42), and adhesion formation was given gross and histopathological scores. Reductions were observed in adhesion extent (P=0.0337) and tenacity (P=0.0271) as well as inflammation (P<0.0001) on Day 3 when medical chitosan was applied. Prior to Day 14, fibrosis was less obvious in the medical chitosan group (P<0.0005). The tenacity scores were significantly lower in the medical chitosan group following Day 14 (P<0.05), while the type scores were lower in the medical chitosan group following Day 28 (P<0.03). Thus, medical chitosan decreased both the gross and the histopathological scores of the induced adhesions.

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“…For one type of barrier [hyaluronate-carboxymethylcellulose, HA-CMC, Seprafilm®, Sanofi, Paris, France], the reduction of incidence for adhesive small bowel obstruction after colorectal surgery has also been established [RR 0.49, 95 % CI 0.28-0.88] without patient harm [60,61]. Oxidized regenerated cellulose [Interceed®, Ethicon, West Somerville, NJ, USA] reduces the incidence of adhesion formation following fertility surgery [RR 0.51, 95 % CI 0.31-0.86], but the impact on small bowel obstruction after gynecological surgery has not been studied [60,62]. Drawback of both products is the difficulty to use in laparoscopic surgery underlining the need to develop gel, spray, or fluid barriers that are easy to apply via a trocar.…”

Section: Anti-adhesion Barriersmentioning

confidence: 99%

Adhesive Small Bowel Obstruction (ASBO)

Simone

Abongwa

Saverio

et al. 2016

Acute Care Surgery Handbook

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Fluid and pharmacological agents for adhesion prevention after gynaecological surgery

Cited by 39 publications

References 49 publications

Efficacy and Safety of Hyaluronic Acid Gel for the Prevention of Intrauterine Adhesion: A Meta-Analysis of Randomized Clinical Trials

Efficacy and Safety of Hyaluronic Acid Gel for the Prevention of Intrauterine Adhesion: A Meta-Analysis of Randomized Clinical Trials

Use of N,O-carboxymethyl chitosan to prevent postsurgical adhesions in a rabbit double uterine horn model: a randomized controlled design

Adhesive Small Bowel Obstruction (ASBO)

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