Design: Systematic review and meta-analyses of randomized controlled trials (RCTs)
Setting: A systematic literature review of the PubMed, Embase, and Cochrane databases according to PRISMA guidelines.
Patients or Participants: N/A
Interventions: Hysteroscopic metroplasty, myomectomy, and adhesiolysis
Measurements and Main Results: Following PROSPERO registration, the electronic search identified 2,214 studies, of which 235 were included following title, abstract, and full-text screening. Six RCTs were identified that made an exclusive comparison of adjuvants with a non-adjuvant arm that could include antibiotic and/or hormone therapy. The relative risk (RR) of IUAs post hysteroscopic metroplasty utilizing gel adjuvant for primary prevention was 0.28 (95% CI: 0.12-0.68, 3 RCTs). However, it was impossible to determine adhesion severity or to derive pooled estimates of the IUA incidence when the septum transection was incomplete following initial surgery. The RR of IUAs post hysteroscopic myomectomy utilizing gel adjuvant for primary prevention was 0.38 (95% CI: 0.20-0.73, 3 RCTs). Unfortunately, there were inadequate studies to allow evaluation of adhesion severity or the incidence of IUAs by myomectomy technique or phenotype including size, FIGO category, number, or with multiple lesions the presence or absence of apposition in the endometrial cavity. In patients undergoing hysteroscopic adhesiolysis utilizing gel adjuvant for secondary prevention, the RR of IUA recurrence was 0.32 (95% CI: 0.17-0.61, RCTs). There were inadequate studies available to estimate the recurrence risk based on the surgical technique used.
Conclusion: These findings demonstrate that gel barriers are efficacious for the primary prevention of IUAs following hysteroscopic metroplasty and myomectomy, and for secondary prevention of IUAs following hysteroscopic adhesiolysis. However, there were limitations on the estimates of IUA severity and inadequate evidence exists evaluating the impact of surgical techniques on the rate or severity of IUAs.
Salazar, CA*1, Bhagavath, B2, Emanuel, MH3, Hooker, AB4, Huddleston, H5, Martin, C6, Sobti, D7, Kumar, J7, Munro, MG8. 1Department of Women’s Health, University of Texas at Austin Dell Medical School, Austin, TX; 2Obstetrics & Gynecology, University of Wisconsin School of Medicine, Middleton, WI; 3Reproductive Medicine & Gynecology, University Medical Center in Utrecht, Utrecht, Netherlands; 4Zaans Medisch Centrum, Zaandam, Netherlands; 5University of California San Francisco Center for Reproductive Health, San Francisco, CA; 6Axtria Health, Berkeley Heights, NJ; 7Axtria, Inc, Delhi, India; 8Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Santa Monica, CA
