Hyaluronic Acid Barrier Gel for Preventing Adhesions After Hysteroscopic Myomectomy of Large Submucosal Myomas

Purpose: To evaluate the effectiveness of an intrauterine hyaluronic acid–based barrier gel in reducing postoperative intrauterine adhesions (IUAs) following hysteroscopic myomectomy for large submucosal myomas. Patients and Methods: This retrospective study reviewed the medical records of 62 women who underwent hysteroscopic myomectomy for submucosal myomas ≥ 3 cm between January 2022 and June 2025. Thirty-three patients received intrauterine application of a hyaluronic acid–based barrier gel at the end of surgery, while 29 patients received no anti-adhesion barrier. The primary outcome was the incidence and severity of postoperative IUAs, assessed by second-look hysteroscopy at 12 weeks using the American Fertility Society scoring system. Secondary outcomes included postoperative menstrual characteristics (PBAC scores), cyclic pelvic pain, and endometrial thickness. Results: Baseline demographic and clinical characteristics were comparable between groups. The incidence of IUAs was significantly lower in the hyaluronic acid gel group compared with controls (6.1% vs 31.0%; p=0.01). The mean total adhesion score was also significantly reduced (0.27 ± 0.89 vs 1.52 ± 2.13; p=0.031). Moderate or severe adhesions occurred only in the control group, although this difference did not reach statistical significance. Postoperative menstrual outcomes and cyclic pelvic pain rates were similar between groups. Endometrial thickness at follow-up tended to be higher in the gel group (7.2 ± 0.9 vs 6.8 ± 0.8 mm; p=0.07). Conclusion: Intrauterine administration of a hyaluronic acid–based barrier gel following hysteroscopic myomectomy for large submucosal myomas significantly reduces the incidence and severity of postoperative intrauterine adhesions, supporting its use as an effective strategy to optimize postoperative uterine cavity outcomes. Keywords: hyaluronic acid barrier gel, intrauterine adhesions, hysteroscopic myomectomy, submucosal fibroids, adhesion prevention, second-look hysteroscopy