Investigating the role of Hyaluronic acid gel as an antiadhesion agent in obstetric and gynecological surgeries

Abstract

Objective: To investigate the efficacy of Hyaluronic acid in reducing adhesion formation in healing, following major gynecological or obstetrical surgeries.

Study Design: Single arm experimental study

Place of study:
• Al-Ihsan Hospital, Rawalpindi
• Rawal General Hospital, Islamabad
• Bangash Hospital, Rawalpindi

Methodology: The study was conducted at three hospitals from August 2018 – Aug 2022 on a total of 130 patients undergoing caesarean section, hysterectomy, myomectomy, and cystectomy. Patients were selected using convenience sampling. Hyaluronic acid gel was injected into the abdominal cavity, covering the raw surfaces following completion of the surgery. Follow-up in OPD or through phone-call was done at to assess pain, quality of wound healing and late signs of adhesion formation.

Results: Age of patients ranged from 21-62 years. Patient had either: no previous (64 , 60%), one previous (32, 30%), two previous (10, 9%), or more than two previous cesarean sections (1, 1%). The most common indication of surgery was lower segment cesarean section (105, 85.4%), followed by laparotomy in (9, 7.3%), myomectomies (8, 6.5%), and one patient had a hysterectomy. 7 patients reported mild to moderate post operative pain (rated on the NPRS scale) on 5th to 7th post operative days. The patients were asked about any symptoms of adhesion (abdominal pain related to surgery). 7 patients underwent additional caesarean sections 1-2 years after their initial surgery. We did not find any adhesions on repeat surgery.

Conclusions: Hyaluronic acid markedly reduces the post operative symptoms associated with adhesion formation with no documented negative effect on wound healing.