Cochrane · systematic review · CD001298
Fluid and pharmacological agents for adhesion prevention after gynaecological surgery
Ahmad, G, Thompson, M, Kim, K, 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
12
No studies
12
Included studies
NR
No studies 12 · 50%Ungraded 0 · 0%Very low 2 · 8.3%Low 4 · 16.7%Moderate 4 · 16.7%High 2 · 8.3%
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 onlyHydroflotation agents versus no hydroflotation agents (or placebo) for adhesion prevention after gynaecological surgery
Population: women undergoing gynaecological surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pelvic pain Hydroflotation agents vs no hydroflotation agents (or placebo) | OR 1.05 [0.52, 2.09] | 1 study · 226 participants | Very low Downgraded: risk of bias, imprecision |
Live birth rate Hydroflotation agents vs no hydroflotation agents (or placebo) | OR 0.67 [0.29, 1.58] | 2 studies · 208 participants | Low Downgraded: imprecision |
Incidence of adhesions at second‐look laparoscopy Hydroflotation agents vs no hydroflotation agents (or placebo) | OR 0.34 [0.22, 0.55] | 4 studies · 566 participants | High |
Mean adhesion score at second‐look laparoscopy Hydroflotation agents vs no hydroflotation agents (or placebo) | no estimate extracted | 4 studies · 722 participants | Moderate Downgraded: risk of bias |
Clinical pregnancy rate Hydroflotation agents vs no hydroflotation agents (or placebo) | OR 0.64 [0.36, 1.14] | 3 studies · 310 participants | Moderate Downgraded: imprecision |
Adverse events Hydroflotation agents vs no hydroflotation agents (or placebo) | no estimate extracted | NR | No studies |
Gel agents versus no gel agents (or placebo) for adhesion prevention after gynaecological surgery
Population: women undergoing gynaecological surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pelvic pain Gel agents vs no gel agents (or placebo) | no estimate extracted | NR | No studies |
Live birth rate Gel agents vs no gel agents (or placebo) | no estimate extracted | NR | No studies |
Incidence of adhesions at second‐look laparoscopy Gel agents vs no gel agents (or placebo) | OR 0.26 [0.12, 0.57] | 5 studies · 147 participants | High |
Mean adhesion score at second‐look laparoscopy Gel agents vs no gel agents (or placebo) | no estimate extracted | 4 studies · 159 participants | Moderate Downgraded: imprecision |
Clinical pregnancy rate Gel agents vs no gel agents (or placebo) | OR 0.2 [0.02, 2.02] | 1 study · 30 participants | Low Downgraded: imprecision |
Adverse events Gel agents vs no gel agents (or placebo) | no estimate extracted | NR | No studies |
Gel agents versus hydroflotation agents used as instillants for adhesion prevention after gynaecological surgery
Population: women during gynaecological surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pelvic pain Gel agents vs hydroflotation agents used | no estimate extracted | NR | No studies |
Live birth rate Gel agents vs hydroflotation agents used | no estimate extracted | NR | No studies |
Incidence of adhesions at second‐look laparoscopy Gel agents vs hydroflotation agents used | OR 0.5 [0.31, 0.83] | 3 studies · 538 participants | Moderate Downgraded: inconsistency |
Mean adhesion score at second‐look laparoscopy Gel agents vs hydroflotation agents used | no estimate extracted | 1 study · 77 participants | Very low Downgraded: risk of bias, imprecision |
Clinical pregnancy rate Gel agents vs hydroflotation agents used | no estimate extracted | NR | No studies |
Adverse events Gel agents vs hydroflotation agents used | no estimate extracted | NR | No studies |
Steroids (any route) versus no steroids (or placebo) for adhesion prevention after gynaecological surgery
Population: women after gynaecological surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pelvic pain Steroids (any route) vs no steroids (or placebo) | no estimate extracted | NR | No studies |
Live birth rate Steroids (any route) vs no steroids (or placebo) | OR 0.65 | 2 studies · 223 participants | Low Downgraded: imprecision |
Incidence of adhesions at second‐look laparoscopy Steroids (any route) vs no steroids (or placebo) | no estimate extracted | NR | No studies |
Mean adhesion score at second‐look laparoscopy Steroids (any route) vs no steroids (or placebo) | no estimate extracted | NR | No studies |
Clinical pregnancy rate Steroids (any route) vs no steroids (or placebo) | OR 1.01 [0.66, 1.55] | 3 studies · 410 participants | Low Downgraded: imprecision |
Adverse events Steroids (any route) vs no steroids (or placebo) | no estimate extracted | NR | No studies |
Hydroflotation agents vs no hydroflotation agents for adhesion prevention after gynaecological surgery
Population: women after gynaecological surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in pelvic pain in participants with a primary diagnosis of pelvic pain, at second‐look laparoscopy Hydroflotation agents vs no hydroflotation agents | OR 0.65 | 1 study · 286 participants | Moderate |
Live birth rate Hydroflotation agents vs no hydroflotation agents | OR 0.67 | 2 studies · 208 participants | Moderate |
Improvement in adhesion score Hydroflotation agents vs no hydroflotation agents | OR 1.27 | 4 studies · 665 participants | Moderate Downgraded: inconsistency |
Number of participants with worsening adhesion score Hydroflotation agents vs no hydroflotation agents | OR 0.28 | 1 study · 53 participants | Moderate Downgraded: imprecision |
Number of participants with adhesions at second‐look laparoscopy Hydroflotation agents vs no hydroflotation agents | OR 0.34 | 4 studies · 566 participants | High |
Mean adhesion score at second‐look laparoscopy Hydroflotation agents vs no hydroflotation agents | no estimate extracted | 4 studies · 722 participants | High |
Clinical pregnancy rate Hydroflotation agents vs no hydroflotation agents | OR 0.64 | 3 studies · 310 participants | Moderate |
Gel agents vs no treatment for adhesion prevention after gynaecological surgery
Population: women after gynaecological surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Number of participants with improvement in adhesion score Gel agents vs no treatment | OR 3.78 | 2 studies · 58 participants | Moderate Downgraded: imprecision |
Number of participants with worsening adhesion score Gel agents vs no treatment | OR 0.16 | 2 studies · 58 participants | Moderate |
Number of participants with adhesions at second‐look laparoscopy Gel agents vs no treatment | OR 0.25 | 4 studies · 134 participants | High |
Mean adhesion score at second‐look laparoscopy Gel agents vs no treatment | no estimate extracted | 2 studies · 58 participants | Moderate |
Gel agents compared with hydroflotation agents when used as an instillant for adhesion prevention after gynaecological surgery
Population: women after gynaecological surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Number of participants with improvement in adhesion score Gel agents vs hydroflotation agents when used | OR 1.55 | 2 studies · 342 participants | Moderate |
Number of participants with worsening adhesion score Gel agents vs hydroflotation agents when used | OR 0.28 | 2 studies · 342 participants | High |
Number of participants with adhesions at second‐look laparoscopy Gel agents vs hydroflotation agents when used | OR 0.36 | 2 studies · 342 participants | High |
Mean adhesion score at second‐look laparoscopy Gel agents vs hydroflotation agents when used | no estimate extracted | 1 study · 77 participants | Moderate |
Steroids (any route) vs no steroids for adhesion prevention after gynaecological surgery
Population: women after gynaecological surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Live birth rate Steroids (any route) vs no steroids | OR 0.65 | 2 studies · 223 participants | Moderate |
Number of participants with improvement in adhesion score Steroids (any route) vs no steroids | OR 4.83 | 1 study · 75 participants | Low |
Number of participants with worsening adhesion score Steroids (any route) vs no steroids | OR 0.27 | 2 studies · 176 participants | Low |
Clinical pregnancy rate Steroids (any route) vs no steroids | OR 1.01 | 3 studies · 410 participants | Moderate |
Ectopic rate (per pregnancy) Steroids (any route) vs no steroids | OR 0.67 | 3 studies · 83 participants | Moderate Downgraded: inconsistency |
Intraperitoneal noxytioline vs no treatment for adhesion prevention after gynaecological surgery
Population: women after gynaecological surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Number of participants with worsening adhesion score Intraperitoneal noxytioline vs no treatment | OR 0.55 | 1 study · 87 participants | Moderate Downgraded: imprecision |
Clinical pregnancy rate Intraperitoneal noxytioline vs no treatment | OR 0.66 | 1 study · 126 participants | Moderate Downgraded: imprecision |
Ectopic pregnancy rate (per pregnancy) Intraperitoneal noxytioline vs no treatment | OR 4.91 | 1 study · 33 participants | Low Downgraded: imprecision |
Intraperitoneal heparin solution vs no intraperitoneal heparin for adhesion prevention after gynaecological surgery
Population: women after gynaecological surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Number of participants with improvement in adhesion score Intraperitoneal heparin solution vs no intraperitoneal heparin | OR 0.87 | 1 study · 63 participants | Low |
Number of participants with worsening adhesion score Intraperitoneal heparin solution vs no intraperitoneal heparin | OR 1.27 | 1 study · 92 participants | Low |
Systemic promethazine vs no promethazine for adhesion prevention after gynaecological surgery
Population: women after gynaecological surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Number of participants with improvement in adhesion score Systemic promethazine vs no promethazine | OR 0.56 | 1 study · 75 participants | Low |
Number of participants with worsening adhesion score Systemic promethazine vs no promethazine | OR 0.59 | 1 study · 93 participants | Low |