Adhesion barriers in laparoscopic myomectomy: Evidence from randomized clinical trials

Objective To evaluate the effectiveness of different adhesion barriers in the prevention of de novo adhesion development after laparoscopic myomectomy. Methods A systematic review was performed by searching seven electronic databases for all randomized clinical trials (RCTs) comparing the use of any absorbable adhesion barrier (i.e. intervention group) with either no treatment or placebo (i.e. control group) in the prevention of adhesion development after laparoscopic myomectomy. Results Eight RCTs with a total of 748 participants (392 in the intervention group and 356 in the control group) were included. The assessed adhesion barrier methods were: oxidized regenerated cellulose (ORC) in two studies, auto‐crosslinked hyaluronic acid (HA) gel in two studies, 4% icodextrin solution in one study, modified HA and carboxy‐methylcellulose in one study, polyethylene glycol ester trilysine amine solution plus a borate buffer solution in one study, and polyethylene glycol amine plus dextran aldehyde polymers in another study. Conclusion Adhesion barrier methods showing the most promising results were: ORC, auto‐crosslinked HA gel, and polyethylene glycol amine plus dextran aldehyde polymers. Synopsis Most promising adhesion barriers after laparoscopic myomectomy are oxidized regenerated cellulose, auto‐crosslinked hyaluronic acid gel, and polyethylene glycol amine plus dextran aldehyde polymers.