Comparison of effectiveness of hyaluronan gel, intrauterine device and their combination for prevention adhesions in patients after intrauterine surgery: Systematic review and meta-analysis.

OBJECTIVE

Our study aims to compare the effects of using hyaluronan gel, an intrauterine device, and their combination to prevent intrauterine adhesions.

METHODS

The systematic review was conducted according to the PRISMA 2020 checklist and has been registered in the PROSPERO.

INCLUSION AND EXCLUSION CRITERIA: randomized controlled trials (RCTs) in English, patients after intrauterine surgery were included. Patients with hypersensitivity and pelvic inflammatory disease were excluded.

DATA SOURCES: PubMed, The Cochrane Library, ClinicalTrials.gov, Embase, and MEDLINE. The search was performed on studies published before February 1, 2021 to identify articles evaluating the effectiveness of hyaluronan gel, an intrauterine device, and their combination in the prevention of intrauterine adhesions.

RESULTS

8 RCTs were included for qualitative analysis reporting on 1226 participants. Five randomized trials compared recurrence rates between two groups: hyaluronan gel and control (RR = 0.53, 95% CI: 0.40 to 0.69, P < .00001). Hyaluronan gel had a significant role on reducing adhesion formation after surgical intervention. Meta-analysis of pregnancy rates compared hyaluronan gel usage and group with IUD or lack of treatment (RR = 1.58, 95% CI: 1.10 to 2.27, P = .01). Hyaluronan gel group had significantly higher pregnancy rates compared with another group in this meta-analysis.

CONCLUSION

Based on our study, it has become more evident that hyaluronic acid is an effective and safe method after adhesiolysis to prevent recurrence and lead to pregnancy in comparison with other techniques. Nevertheless, further research is needed to achieve more answers regarding adhesions prevention.