Effectiveness of Hyaluronic Acid Gel in Preventing Postoperative Intrauterine Adhesion Formation Following Operative Hysteroscopy

Objective: To evaluate the effectiveness of intrauterine hyaluronic acid (HA) gel application in preventing postoperative intrauterine adhesion formation following operative hysteroscopy. Methods: This retrospective comparative study was conducted at a tertiary referral center and included women who underwent operative hysteroscopy between January 2024 and December 2024. Patients were divided into two groups according to postoperative management: those who received intrauterine hyaluronic acid gel application and those who did not receive any adhesion barrier. All patients underwent follow-up evaluation with second-look hysteroscopy between 30 days and 6 months after surgery. The primary outcome was the incidence of postoperative intrauterine adhesion formation. Secondary outcomes included adhesion type, cavity involvement according to the American Fertility Society (AFS) classification, and menstrual pattern changes. Results: A total of 77 patients were included in the final analysis, including 34 patients in the HA gel group and 43 patients in the control group. Postoperative intrauterine adhesions were detected in 22 patients (28.6%). The incidence of adhesion formation was significantly lower in the HA gel group compared with the control group (8.8% vs. 43.2%, p = 0.001). Adhesions observed in the HA gel group were predominantly filmy in nature, and all observed adhesions involved less than one-third of the uterine cavity. Improvement in menstrual patterns was observed in all patients in the HA gel group and in 78.9% of patients in the control group. The use of hyaluronic acid gel resulted in an absolute risk reduction of 34.4% and a relative risk reduction of approximately 80% in adhesion formation. Conclusion: Intrauterine application of hyaluronic acid gel following operative hysteroscopy was associated with a lower incidence of postoperative intrauterine adhesions and descriptively milder adhesion characteristics. HA gel may represent a useful adjunct for adhesion prevention; however, larger prospective studies are required to confirm these findings. Keywords: adhesion prevention, hyaluronic acid, hysteroscopy, intrauterine adhesions, second-look hysteroscopy