Hyaluronic Acid Agents Could Prevent Adhesions After Gynecologic Surgery

Adhesion formation after fertility-preserving gynecologic surgery may be decreased with the use of hyaluronic acid-based fluid agents, according to a new study.

Researchers at the University of Sheffield (United Kingdom; www.shef.ac.uk) conducted a meta-analysis of available studies from the Cochrane menstrual disorders and subfertility group specialized register of controlled trials, The Cochrane central register of controlled trials, MEDLINE, and EMBASE and identified four randomized controlled trials of hyaluronic acid fluid agents compared with no treatment or placebo in women undergoing fertility-preserving gynecologic surgery.

An association was observed between the use of hyaluronic acid agents and a decrease in the prevalence of adhesions at second-look laparoscopy. Patients treated with hyaluronic acid also had a decreased chance of deterioration of preexisting adhesions. However, the researchers concluded that the severity of adhesions should not be used as a surrogate marker for future fertility potential, and therefore, future studies should include live birth rate as a primary outcome measure and have adequate follow-up periods. The study was published in the May 2007 issue of Fertility and Sterility.

"Intraperitoneal adhesions are an important cause of postoperative intestinal obstruction, abdominal discomfort, and infertility,” said lead author Dr. Mostafa Metwally. "Despite careful attention to minimize tissue trauma and ensure hemostasis, pelvic surgery is associated with both de novo adhesion formation and reformation.”

Hyaluronic acid (also called hyaluronan or hyaluronate) is a glycosaminoglycan found in lubricating proteoglycans of the synovial fluid, vitreous humors, cartilage, blood vessels, skin, and the umbilical cord. It is one of the chief components of the extracellular matrix, and contributes significantly to cell proliferation and migration.


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