Barrier agents for adhesion prevention after gynaecological surgery

Pelvic adhesions can form secondary to inflammation, endometriosis, or surgical trauma. Strategies to reduce pelvic adhesion formation include placing barrier agents such as oxidised regenerated cellulose, polytetrafluoroethylene, and fibrin or collagen sheets between pelvic structures. To evaluate...

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Bibliographic Details
Published in:Cochrane database of systematic reviews 2020-03, Vol.3 (3), p.CD000475
Main Authors: Ahmad, Gaity, Kim, Kyungmin, Thompson, Matthew, Agarwal, Priya, O'Flynn, Helena, Hindocha, Akshay, Watson, Andrew
Format: Article
Language:English
Subjects:
Cellulose, Oxidized - therapeutic use
Cervix Uteri - surgery
Collagen - administration & dosage
EVALUATION OF SUBFERTILITY TREATMENTS RELATING TO THE FEMALE PARTNER
Female
Fibrin - administration & dosage
Glycerol - administration & dosage
Gynaecology
Humans
Hyaluronic Acid - administration & dosage
Incidence
Infertility, Female - surgery
Laparoscopy - adverse effects
Laparotomy - adverse effects
Membranes, Artificial
Pain, Postoperative - prevention & control
Pelvis - surgery
Polyethylene Glycols - administration & dosage
Polytetrafluoroethylene - administration & dosage
Postoperative Complications - epidemiology
Postoperative Complications - prevention & control
Pregnancy
Pregnancy Rate
Randomized Controlled Trials as Topic
Second-Look Surgery
Tissue Adhesions - epidemiology
Tissue Adhesions - prevention & control
Viscosupplements - administration & dosage
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Summary:Pelvic adhesions can form secondary to inflammation, endometriosis, or surgical trauma. Strategies to reduce pelvic adhesion formation include placing barrier agents such as oxidised regenerated cellulose, polytetrafluoroethylene, and fibrin or collagen sheets between pelvic structures. To evaluate the effects of barrier agents used during pelvic surgery on rates of pain, live birth, and postoperative adhesions in women of reproductive age. We searched the following databases in August 2019: the Cochrane Gynaecology and Fertility (CGF) Specialised Register of Controlled Trials, MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, the Cochrane Central Register of Controlled Trials (CENTRAL), Epistemonikos, and trial registries. We searched reference lists of relevant papers, conference proceedings, and grey literature sources. We contacted pharmaceutical companies for information and handsearched relevant journals and conference abstracts. Randomised controlled trials (RCTs) on the use of barrier agents compared with other barrier agents, placebo, or no treatment for prevention of adhesions in women undergoing gynaecological surgery. Three review authors independently assessed trials for eligibility and risk of bias and extracted data. We calculated odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs) using a fixed-effect model. We assessed the overall quality of the evidence using GRADE (Grades of Recommendation, Assessment, Development and Evaluation) methods. We included 19 RCTs (1316 women). Seven RCTs randomised women; the remainder randomised pelvic organs. Laparoscopy (eight RCTs) and laparotomy (11 RCTs) were the primary surgical techniques. Indications for surgery included myomectomy (seven RCTs), ovarian surgery (five RCTs), pelvic adhesions (five RCTs), endometriosis (one RCT), and mixed gynaecological surgery (one RCT). The sole indication for surgery in three of the RCTs was infertility. Thirteen RCTs reported commercial funding; the rest did not state their source of funding. No studies reported our primary outcomes of pelvic pain and live birth rate. Oxidised regenerated cellulose versus no treatment at laparoscopy or laparotomy (13 RCTs) At second-look laparoscopy, we are uncertain whether oxidised regenerated cellulose at laparoscopy reduced the incidence of de novo adhesions (OR 0.50, 95% CI 0.30 to 0.83, 3 RCTs, 360 participants; I² = 75%; very low-quality evidence) o
ISSN:1469-493X
1469-493X
DOI:10.1002/14651858.CD000475.pub4