Investigating The Role of Hyaluronic Acid Gel as an Antiadhesion Agent in Obstetric and Gynecological Surgeries

Abstract

Objective: To determine the effectiveness of Hyaluronic acid in reducing adhesion formation during the healing process following major gynecological or obstetrical surgeries.

Methodology: This single-arm observational study was conducted at three hospitals from August 2018 to August 2022. Patients undergoing cesarean section, hysterectomy, myomectomy, and cystectomy, who provided consent for the use of hyaluronic acid gel, were included. Hyaluronic acid gel was injected into the abdominal cavity, covering the raw surfaces after the completion of surgery. Follow-up was conducted in the outpatient department or through phone calls to assess pain, quality of wound healing, and late signs of adhesion formation. Data was entered and analyzed using SPSS version 26.

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

Conclusions: The application of hyaluronic acid gel as an anti-adhesion agent was observed to be effective in reducing postoperative symptoms related to adhesion formation, without any reported adverse impacts on wound healing.