Cochrane · systematic review · CD000475
Barrier agents for adhesion prevention after gynaecological surgery
Ahmad, G, Kim, K, Thompson, M, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
24
current version
GRADE rated
10
No studies
14
Included studies
NR
No studies 14 · 58.3%Ungraded 0 · 0%Very low 8 · 33.3%Low 2 · 8.3%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyAnalysis 1 ‐ Oxidised regenerated cellulose vs no treatment at laparoscopy for adhesion prevention after gynaecological surgery
Population: women having gynaecological surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pelvic pain Analysis 1 ‐ Oxidised regenerated cellulose vs no treatment at laparoscopy | no estimate extracted | NR | No studies |
Live birth rate Analysis 1 ‐ Oxidised regenerated cellulose vs no treatment at laparoscopy | no estimate extracted | NR | No studies |
Adhesion score Analysis 1 ‐ Oxidised regenerated cellulose vs no treatment at laparoscopy | no estimate extracted | NR | No studies |
Incidence of adhesions ‐ de novo Incidence of adhesions at second‐look laparoscopy Analysis 1 ‐ Oxidised regenerated cellulose vs no treatment at laparoscopy | OR 0.5 [0.3, 0.83] | 3 studies · 360 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Incidence of adhesions ‐ re‐formation (or mixture) Incidence of adhesions at second‐look laparoscopy Analysis 1 ‐ Oxidised regenerated cellulose vs no treatment at laparoscopy | OR 0.17 [0.07, 0.41] | 3 studies · 100 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Clinical pregnancy rate Analysis 1 ‐ Oxidised regenerated cellulose vs no treatment at laparoscopy | no estimate extracted | NR | No studies |
Analysis 2 ‐ Oxidised regenerated cellulose vs no treatment at laparotomy for adhesion prevention after gynaecological surgery
Population: women having gynaecological surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pelvic pain Analysis 2 ‐ Oxidised regenerated cellulose vs no treatment at laparotomy | no estimate extracted | NR | No studies |
Live birth rate Analysis 2 ‐ Oxidised regenerated cellulose vs no treatment at laparotomy | no estimate extracted | NR | No studies |
Adhesion score Analysis 2 ‐ Oxidised regenerated cellulose vs no treatment at laparotomy | no estimate extracted | NR | No studies |
Incidence of adhesions ‐ de novo Incidence at second‐look laparoscopy Analysis 2 ‐ Oxidised regenerated cellulose vs no treatment at laparotomy | OR 0.72 [0.42, 1.25] | 1 study · 271 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Incidence of adhesions ‐ re‐formation (or mixture) Incidence at second‐look laparoscopy Analysis 2 ‐ Oxidised regenerated cellulose vs no treatment at laparotomy | OR 0.38 [0.27, 0.55] | 6 studies · 554 participants | Low Downgraded: risk of bias, inconsistency, publication bias |
Clinical pregnancy rate Analysis 2 ‐ Oxidised regenerated cellulose vs no treatment at laparotomy | no estimate extracted | NR | No studies |
Analysis 4 ‐ Expanded polytetrafluoroethylene vs oxidised regenerated cellulose for adhesion prevention after gynaecological surgery
Population: women having gynaecological surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pelvic pain Analysis 4 ‐ Expanded polytetrafluoroethylene vs oxidised regenerated cellulose | no estimate extracted | NR | No studies |
Live birth rate Analysis 4 ‐ Expanded polytetrafluoroethylene vs oxidised regenerated cellulose | no estimate extracted | NR | No studies |
Adhesion score Non‐validated score out of 11 at SLL Analysis 4 ‐ Expanded polytetrafluoroethylene vs oxidised regenerated cellulose | no estimate extracted | 1 study · 58 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Incidence of adhesions ‐ de novo Incidence at second‐look laparoscopy Analysis 4 ‐ Expanded polytetrafluoroethylene vs oxidised regenerated cellulose | OR 0.93 [0.26, 3.41] | 1 study · 38 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Incidence of adhesions ‐ re‐formation (or mixture) Incidence at second‐look laparoscopy Analysis 4 ‐ Expanded polytetrafluoroethylene vs oxidised regenerated cellulose | OR 0.13 [0.02, 0.8] | 1 study · 23 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Clinical pregnancy rate Analysis 4 ‐ Expanded polytetrafluoroethylene vs oxidised regenerated cellulose | no estimate extracted | NR | No studies |
Analysis 7 ‐ Collagen membrane with polyethylene glycol and glycerol vs Ringer's lactate
Population: patients with adhesion prevention after gynaecological surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pelvic pain Analysis 7 ‐ Collagen membrane with polyethylene glycol and glycerol vs Ringer's lactate | no estimate extracted | NR | No studies |
Live birth rate Analysis 7 ‐ Collagen membrane with polyethylene glycol and glycerol vs Ringer's lactate | no estimate extracted | NR | No studies |
Adhesion score Analysis 7 ‐ Collagen membrane with polyethylene glycol and glycerol vs Ringer's lactate | no estimate extracted | 1 study · 47 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Incidence of adhesions ‐ de novo Incidence at second‐look laparoscopy Analysis 7 ‐ Collagen membrane with polyethylene glycol and glycerol vs Ringer's lactate | OR 0.04 [0, 0.77] | 1 study · 47 participants | Low Downgraded: risk of bias, imprecision, publication bias |
Incidence of adhesions ‐ re‐formation or mixture Incidence at second‐look laparoscopy Analysis 7 ‐ Collagen membrane with polyethylene glycol and glycerol vs Ringer's lactate | no estimate extracted | NR | No studies |
Clinical pregnancy rate Analysis 7 ‐ Collagen membrane with polyethylene glycol and glycerol vs Ringer's lactate | OR 5.69 [1.38, 23.48] | 1 study · 39 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Oxidised regenerated cellulose (Interceed) vs no treatment at laparoscopy for adhesion prevention after gynaecological surgery
Population: women having gynaecological surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Incidence of adhesions—de novo Incidence of adhesions at second‐look laparoscopy Oxidised regenerated cellulose (Interceed) vs no treatment at laparoscopy | OR 0.5 [0.3, 0.83] | 3 studies · 360 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Incidence of adhesions—re‐formation (or mixture) Incidence of adhesions at second‐look laparoscopy Oxidised regenerated cellulose (Interceed) vs no treatment at laparoscopy | OR 0.17 [0.07, 0.41] | 3 studies · 100 participants | Low Downgraded: risk of bias, imprecision, publication bias |
Oxidised regenerated cellulose (Interceed) vs no treatment at laparotomy for adhesion prevention after gynaecological surgery
Population: women having gynaecological surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Incidence of adhesions—de novo Incidence at second‐look laparoscopy Oxidised regenerated cellulose (Interceed) vs no treatment at laparotomy | OR 0.72 [0.42, 1.25] | 1 study · 271 participants | Low Downgraded: risk of bias, imprecision, publication bias |
Incidence of adhesions—re‐formation (or mixture) Incidence at second‐look laparoscopy Oxidised regenerated cellulose (Interceed) vs no treatment at laparotomy | OR 0.38 [0.27, 0.55] | 6 studies · 554 participants | Moderate Downgraded: risk of bias, imprecision, publication bias |
Expanded polytetrafluoroethylene (Gore‐Tex) vs no treatment for adhesion prevention after gynaecological surgery
Population: women having gynaecological surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Incidence of adhesions—de novo Incidence at second‐look laparoscopy Expanded polytetrafluoroethylene (Gore‐Tex) vs no treatment | OR 0.17 [0.03, 0.94] | 1 study · 42 participants | Low Downgraded: imprecision |
Expanded polytetrafluoroethylene (Gore‐Tex) vs oxidised regenerated cellulose (Interceed) for adhesion prevention after gynaecological surgery
Population: women having gynaecological surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adhesion score Non‐validated score out of 11 at SLL Expanded polytetrafluoroethylene (Gore‐Tex) vs oxidised regenerated cellulose (Interceed) | no estimate extracted | 1 study · 58 participants | Very low Downgraded: imprecision |
Incidence of adhesions—de novo Incidence at second‐look laparoscopy Expanded polytetrafluoroethylene (Gore‐Tex) vs oxidised regenerated cellulose (Interceed) | OR 0.93 [0.26, 3.41] | 1 study · 38 participants | Very low Downgraded: imprecision |
Incidence of adhesions—re‐formation (or mixture) Incidence at second‐look laparoscopy Expanded polytetrafluoroethylene (Gore‐Tex) vs oxidised regenerated cellulose (Interceed) | OR 0.13 [0.02, 0.8] | 1 study · 23 participants | Very low Downgraded: risk of bias, imprecision |
Sodium hyaluronate and carboxymethylcellulose (Seprafilm) vs no treatment for adhesion prevention after gynaecological surgery
Population: patients with adhesion prevention after gynaecological surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adhesion score Non‐validated score out of 4 at second‐look laparoscopy Sodium hyaluronate and carboxymethylcellulose (Seprafilm) vs no treatment | no estimate extracted | 1 study · 127 participants | Moderate Downgraded: risk of bias |
Fibrin sheet vs no treatment at laparoscopic myomectomy for adhesion prevention after gynaecological surgery
Population: patients with adhesion prevention after gynaecological surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adhesion score Non‐validated score out of 4 at at second‐look laparoscopy Fibrin sheet vs no treatment at laparoscopic myomectomy | no estimate extracted | 1 study · 62 participants | Low Downgraded: imprecision |
Incidence of adhesions per participant Incidence at at second‐look laparoscopy Fibrin sheet vs no treatment at laparoscopic myomectomy | OR 1.2 [0.42, 3.41] | 1 study · 62 participants | Very low Downgraded: imprecision |