Hum. Reprod. Advance Access originally published online on January 26, 2006
Human Reproduction 2006 21(5):1248-1254; doi:10.1093/humrep/dei488
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Reduction of postoperative adhesions with an auto-crosslinked hyaluronan gel in gynaecological laparoscopic surgery: a blinded, controlled, randomized, multicentre study
1 Division of Gynecology, Obstetrics and Pathophysiology of Human Reproduction, Department of Surgery, Maternal–Fetal Medicine and Imaging, University of Cagliari, Ospedale S. Giovanni di Dio, Cagliari, 2 Department of Gynecology, Perinatology and Human Reproduction, University of Florence, Florence, 3 Department of Human Reproduction Sciences, 2nd Gynecology Clinic, University of Padua, Padua and 4 Department of Obstetrics and Gynecology, Ospedale Maria Vittoria, Corso Tassoni, Turin, Italy
5 To whom correspondence should be addressed at: Division of Gynecology, Obstetrics and Pathophysiology of Human Reproduction, Department of Surgery, Maternal–Fetal Medicine and Imaging, University of Cagliari, Ospedale S. Giovanni di Dio, Via Ospedale 46, 09124 Cagliari, Italy. E-mail: gineca.vmais{at}tiscali.it
BACKGROUND: Following myomectomy, postoperative adhesions occur in many patients with adverse effects on fertility. This study investigated the applicability, safety and efficacy of an auto-crosslinked hyaluronan gel in preventing adhesion formation after laparoscopic myomectomy. METHODS: Fifty-two patients aged 22–42 years, undergoing surgery at four centres, were randomly allocated to receive either the gel or no adhesion prevention. The incidence and severity of postoperative adhesions were assessed laparoscopically after 12–14 weeks in a blinded, scored fashion. The primary efficacy variable was the presence/absence of postoperative adhesions at second-look. RESULTS: A nonsignificantly higher proportion of patients receiving the gel were free from adhesions (13 of 21; 62%) compared with control patients (9 of 22; 41%), with a statistically significant difference between the severity of uterine adhesions at baseline and at second-look (0.3 ± 0.9 versus 0.8 ± 1.0, P < 0.05). In subjects undergoing myomectomy without concomitant surgery, the proportion of adhesion-free patients was 8 of 12 (67%) and 4 of 11 (36%) (not significant) in the gel and control groups, respectively, with a significant difference in the mean severity scores (P < 0.05). In subjects without uterine adhesions before myomectomy, 12 of 18 (67%) and 8 of 20 (40%) patients in the gel and control groups, respectively were adhesion-free (not significant), with a significant difference in the severity of uterine adhesions (P = 0.05). CONCLUSIONS: Our results suggest that the auto-crosslinked hyaluronan gel may have a favourable safety profile and efficacious antiadhesive action following laparoscopic myomectomy.
Key words: adhesions/hyaluronic acid/laparoscopy/myomectomy/prevention
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