Crosslinked Hyaluronic Acid Gels for the Prevention of Intrauterine Adhesions after a Hysteroscopic Myomectomy in Women with Submucosal Myomas: A Prospective, Randomized, Controlled Trial.

Peng-Hui Wang,Chen-Yu Huang,Wen-Hsun Chang,Wen-Ling Lee,Yi-Jen Chen,Huann-Cheng Horng,Min Cheng,Hsin-Yi Huang

doi:10.3390/life10050067

Abstract

Intrauterine adhesion (IUA), fibrosis, and scarring resulting from damage to the endometrium is a rare but serious clinical disease, contributing to a significant impairment of reproductive function. Uterine instrumentation, especially that of a hysteroscopic myomectomy, has become the main cause of IUA. Therefore, a prospective randomized controlled study to assess the effectiveness and short-term safety of the use of hyaluronic acid gels in the prevention of IUA after a hysteroscopic myomectomy and an evaluation of the characteristics of IUA observed at follow-up are presented here. A total of 70 patients were analyzed at the end of 16 March 2020. The results show that the incidence of IUA in women who underwent a hysteroscopic myomectomy is 21.4% (15/70), overall. Women treated with hyaluronic acid gels have a statistically significantly lower incidence of IUAs than non-treated women (12.8% vs. 39.1%, p = 0.012). In addition, women in the anti-adhesive gel treatment group had a dramatically reduced severity of IUA than women in the no-treatment group (p = 0.002). Further analysis shows that the International Federation of Gynecology and Obstetrics (FIGO) classification type and the use of anti-adhesive gels are independent factors associated with moderate and severe degrees of IUA formation. The results here highlight the significant therapeutic benefits of the application of hyaluronic acid gels in women undergoing a hysteroscopic myomectomy, especially for those patients with a uterine myoma classified as FIGO type 2. Since the risk of IUA after a hysteroscopic myomectomy is high, especially for patients who have not received prophylactic anti-adhesive gels, the application of hyaluronic acid gels as a prevention strategy is highly recommended. More studies are encouraged to confirm our observation.

Highlights

Dr Heinrich Fritsch reported the first case of post-traumatic intrauterine adhesion (IUA) in1894 [1]
When the IUA was detected according to the modified AFS scoring system, we found that the women in the anti-adhesive agent gel treatment group had a statistically significantly lower severity of IUA development than those women in the no-treatment group did (p = 0.002)
A further stepwise logistical regression analysis was performed to identify the dominant key factors, and the results showed that uterine myoma classified as Federation of Gynecology and Obstetrics (FIGO) type 2 and the application of postoperative anti-adhesive gels significantly influenced the development of modified AFS Stage II to III IUA in patients after a hysteroscopic myomectomy (Table 6)

Summary

Introduction

Dr Heinrich Fritsch reported the first case of post-traumatic intrauterine adhesion (IUA) in1894 [1]. Dr Heinrich Fritsch reported the first case of post-traumatic intrauterine adhesion (IUA) in. A large number of cases describing IUA have been reported in the literature [3,4,5,6,7,8,9]; IUA is often overlooked and considered a rare disease, partly because of a great variation in clinical features and vague symptoms and partly because of neglect and a failure to diagnose this disease, even for patients that present clear symptoms [4,5,6,7,8], resulting in an uncertain incidence or prevalence [10,11,12,13,14,15,16,17,18,19,20,21,22,23]. When extensive damage to the endometrium occurs, especially in certain conditions with trauma deep in the basal layer, the endometrial lining might be partially or totally absent, resulting in the approximation and fusion of surfaces on the opposite uterine wall.

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