A Cochrane review [Abstract] 1 included 7 studies with a total of 2 329 subjects. 6 studies compared HA/CMC and one 0.5% ferric hyaluronate gel against controls. HA/CMC reduced the incidence of adhesions (OR 0.15, 95% CI 0.05 to 0.43; 3 studies, n=335), the extent of adhesions (WMD -25.9%, 95% CI -40.56 to -11.26; 2 studies, n=220) and severity of adhesions, assessed at second planned surgery (done for ileostomy closure or for other reason). There was no difference in the total incidence of intestinal obstruction of all causes (OR 0.84, 95% CI 0.34 to 2.08; 2 studies, n=1850) or in the incidence of adhesive intestinal obstruction needing surgical intervention (OR 0.84, 95% CI 0.24 to 2.7). There were no statistically significant differences in the incidence of wound infection (OR 1.18, 95% CI 0.77 to 1.80; 4 studies, n=2136), abdominal or pelvic infection (OR 1.92, 95% CI 0.95 to 3.92; 3 studies, n=2094), or anastomotic leak (OR 1.61, 95%CI 0.69 to 3.71; 4 studies, n=2164) between the intervention and control groups. In one study, the incidence of anastomotic leaks was particularly high in the subgroup where HA/CMC membrane was wrapped around the anastomosis, and the difference was statistically significant when compared to control in this particular study. The study of 0.5% ferric hyaluronate gel was prematurely terminated and no valid conclusions could be made but there was a higher incidence of overall morbidity (OR 5.04, 95% CI 1.1 to 22.9) and ileus (OR 9.29, 95% CI 1.57 to 54.77).
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and more than 20% loss to follow up) and by imprecise results (wide confidence intervals).
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