The Efficacy of Self-Cross-Linked Sodium Hyaluronate Gel in the Prevention of Intrauterine Adhesions: A Literature Review

Abstract

Objective: Intrauterine adhesions (IUAs) are primarily addressed through hysteroscopic surgery, and the clinical application of self-cross-linked sodium hyaluronate gel has progressively gained traction to prevent postoperative recurrence, alterations in uterine morphology, and menstrual irregularities. Clinicians frequently employ sodium hyaluronate gel in combination with an intrauterine device (IUD) or balloon; however, the precise effectiveness of these combined approaches warrants further investigation. Accordingly, this study aimed to synthesize the outcomes of various treatment modalities reported in existing research and summarize the outcome measures employed, thereby providing valuable insights and references for the field. Findings in Brief: Our findings indicate that using self-cross-linked sodium hyaluronate gel alone significantly reduces the severity of adhesions in patients with uterine adhesions, but has no considerable effect on those with mild adhesions. The postoperative recurrence rate of adhesions was significantly lower in patients who received a combined therapy of a gel and a uterine balloon or IUD, compared to those treated with the gel alone. Additionally, the combined gel and electrophysiological techniques enhanced local blood circulation in the pelvic floor and mitigated scar tissue formation in the uterus, reducing IUAs. However, none of the three treatment modalities demonstrated a significant impact on the final pregnancy outcomes of the patients. Conclusions: Self-cross-linked sodium hyaluronate gel proves effective in preventing postoperative recurrence in patients with IUAs; however, further research is required to elucidate the impact of these gels on patients with mild versus severe adhesions. Future studies should consider conducting high-quality, large-scale randomized controlled trials to compare the therapeutic efficacy of these approaches, thereby advancing their clinical application.

Keywords

• self-cross-linking sodium hyaluronate gel
• intrauterine adhesion
• endometrium
• operative hysteroscopy