Hydroflotation agents probably made little or no difference to mean adhesion score at SLL (standardised mean difference (SMD) -0.06, 95% CI -0.20 to 0.09 four studies, 722 women moderate-quality evidence). The evidence suggests that in women with an 84% chance of having adhesions at SLL with no treatment, using hydroflotation agents would result in 54% to 75% having adhesions. Hydroflotation agents reduced the incidence of adhesions at SLL when compared with no treatment (OR 0.34, 95% CI 0.22 to 0.55, four studies, 566 women high-quality evidence). It is unclear whether hydroflotation agents affected live birth rates (OR 0.67, 95% CI 0.29 to 1.58 two studies, 208 women low-quality evidence) compared with no treatment. We are uncertain whether hydroflotation agents affected pelvic pain (odds ratio (OR) 1.05, 95% confidence interval (CI) 0.52 to 2.09 one study, 226 women very low-quality evidence). Hydroflotation agents versus no hydroflotation agents (10 RCTs). We were unable to include data from nine studies in the statistical analyses, but the findings of these studies were broadly in keeping with the findings of the meta-analyses. Main results: We included 32 trials (3492 women), and excluded 11. Outcomes of interest were pelvic pain live birth rates incidence of, mean, and changes in adhesion scores at second look-laparoscopy (SLL) clinical pregnancy, miscarriage, and ectopic pregnancy rates quality of life at SLL and adverse events. We assessed the overall quality of the evidence using GRADE methods. Data collection and analysis: We used standard methodological procedures recommended by Cochrane. Selection criteria: Randomised controlled trials investigating the use of fluid (including gel) and pharmacological agents to prevent adhesions after gynaecological surgery. We also checked the reference lists of relevant papers and contacted experts in the field. Search methods: We searched: the Cochrane Gynaecology and Fertility Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, and Epistemonikos to 22 August 2019.
Objectives: To evaluate the effectiveness and safety of fluid and pharmacological agents on rates of pain, live births, and adhesion prevention in women undergoing gynaecological surgery. Strategies to prevent adhesion formation include the use of fluid (also called hydroflotation) and gel agents, which aim to prevent healing tissues from touching one another, or drugs, aimed to change an aspect of the healing process, to make adhesions less likely to form. Adhesions also increase the likelihood of further surgery, causing distress and unnecessary expenses. Adhesions are associated with comorbidities, including pelvic pain, subfertility, and small bowel obstruction. They are caused by conditions that include pelvic inflammatory disease and endometriosis. Background: Adhesions are fibrin bands that are a common consequence of gynaecological surgery.
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