Design: Systematic literature review and meta-analyses of randomized controlled trials (RCT's).

Setting: According to the PRISMA guidelines, a search was performed in PubMed, Embase, and Cochrane databases to assess the efficacy of the application of HA following intrauterine interventions.

Patients or Participants: N/A

Interventions: Hyaluronic Acid gel application after Intrauterine Surgical Procedures

Measurements and Main Results: The search was limited to humans and studies published in the English language. Only randomized trials that made an exclusive prospective comparison of HA application with a control group were included. Searches using the Medical Subject Headings (MeSH) terms included IUA and intrauterine surgery related to the removal of retained products of conception (RPOC), hysteroscopic myomectomy, hysteroscopic adhesiolysis, and hysteroscopic metroplasty. No date limits were applied. Meta-analyses were performed for the separate outcomes, and each included study was subjected to risk of bias analysis. The primary outcome was the incidence and severity of IUA.

An electronic search identified 2,214 studies. After title, abstract, and full-text screening of 423 of them, seven RCTs were identified and included studying HA application after the following procedures: two RCTs studied the effect after the removal of RPOC, two after hysteroscopic myomectomy, two after hysteroscopic metroplasty, two following hysteroscopic adhesiolysis and one included women after different intrauterine procedures. The relative risk of IUA after postsurgical application of HA gel was 0.42 (95% confidence Interval (CI): 0.25-0.72) after evacuation of RPOC, 0.39 (95% CI: 0.20-0.77) after hysteroscopic myomectomy, 0.31 (95% CI: 0.12-0.77) after hysteroscopic metroplasty and 0.32 (95% CI: 0.17-0.61) after hysteroscopic adhesiolysis.

Conclusion: Intrauterine application of HA significantly reduces the formation of IUA after evacuation of RPOC and hysteroscopic myomectomy, metroplasty, and adhesiolysis.