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Open AccessArticle

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

by Chen-Yu Huang 1,2,3, Wen-Hsun Chang 1,2,4, Min Cheng 1,2,3, Hsin-Yi Huang 5, Huann-Cheng Horng 1,2,3, Yi-Jen Chen 1,2,3, Wen-Ling Lee 2,6,7,* and Peng-Hui Wang 1,2,3,8,9,*
1
Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei 112, Taiwan
2
Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan
3
Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei 112, Taiwan
4
Department of Nursing, Taipei Veterans General Hospital, Taipei 112, Taiwan
5
Biostatics Task Force, Taipei Veterans General Hospital, Taipei 112, Taiwan
6
Department of Medicine, Cheng-Hsin General Hospital, Taipei 112, Taiwan
7
Department of Nursing, Oriental Institute of Technology, New Taipei City 220, Taiwan
8
Female Cancer Foundation, Taipei 104, Taiwan
9
Department of Medical Research, China Medical University Hospital, Taichung 404, Taiwan
*
Authors to whom correspondence should be addressed.
Life 2020, 10(5), 67; https://doi.org/10.3390/life10050067
Received: 20 April 2020 / Revised: 10 May 2020 / Accepted: 13 May 2020 / Published: 15 May 2020
(This article belongs to the Special Issue Reproductive Health Concerns for Women)
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. View Full-Text
Keywords: anti-adhesive gel; hyaluronic acid; hysteroscopic myomectomy; intrauterine adhesion; prevention; reduction anti-adhesive gel; hyaluronic acid; hysteroscopic myomectomy; intrauterine adhesion; prevention; reduction
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Huang, C.-Y.; Chang, W.-H.; Cheng, M.; Huang, H.-Y.; Horng, H.-C.; Chen, Y.-J.; Lee, W.-L.; Wang, P.-H. Crosslinked Hyaluronic Acid Gels for the Prevention of Intrauterine Adhesions after a Hysteroscopic Myomectomy in Women with Submucosal Myomas: A Prospective, Randomized, Controlled Trial. Life 2020, 10, 67.

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