Efficacy of a Polyethylene Oxide-Sodium Carboxymethylcellulose Gel in Prevention of Intrauterine Adhesions After Hysteroscopic Surgery

Study Objectives: To assess the efficacy of a polyethylene oxide sodium carboxymethylcellulose gel (Intercoat; Gynecare, division of Ethicon, Inc., Somerville, NJ) in preventing the development of de novo intrauterine adhesions (IUAs) after hysteroscopic surgery and to rate the patency of the internal uterine ostium at 1-month follow-up diagnostic hysteroscopy. Design: Randomized controlled study (Canadian Task Force classification I). Setting: University hospital. Patients: One hundred ten patients diagnosed during office hysteroscopy as having single or multiple lesions suitable for surgical treatment or resistant dysfunctional uterine bleeding requiring endometrial ablation. Interventions: Patients were randomized to 2 groups. Group I underwent hysteroscopic surgery plus intrauterine application of Intercoat gel, and group 2 underwent hysteroscopic surgery only (control group). Follow-up office hysteroscopy was performed at 1 month after surgery to assess the rate and severity of IUA formation and to rate the patency of the internal uterine ostium after the surgical intervention. Measurements and Main Results: Compared with the group 2, group I demonstrated a significant reduction in the incidence (6% vs 22%; p < .05) of de-novo IUAs. Application of the gel seemed to reduce the severity of IUAs, with fewer moderate and severe IUAs at follow-up in group I in comparison with group 2 (33% vs 92%). Furthermore, group 1 demonstrated significant improvement in the degree of patency of the internal uterine ostium (41.9% of cases) in comparison with diagnostic office hysteroscopy performed at enrollment (p < .05). In contrast, in group 2, worsening of patency of the internal uterine ostium was recorded in 18.2% of cases (p < .05). Conclusions: Intercoat gel seems to prevent de novo formation of IUAs and to improve the patency of the internal uterine ostium at follow-up hysteroscopy. However, larger studies are needed to confirm these findings. Journal of Minimally Invasive Gynecology (2011) 18, 462-469 (C) 2011 AAGL. All rights reserved.