Prevention of recurrence of intrauterine adhesions after hysteroscopic adhesiolysis: a systematic review and network meta-analysis of randomized controlled trials

Le résumé fourni par la source

The aim of this network meta-analysis (NMA) is to comprehensively analyze the effectiveness of different postoperative interventions for Intrauterine adhesion (IUA) recurrence prevention. Literature searching was performed to select eligible studies published prior to March 11, 2026 in PubMed, Cochrane and Embase. Randomized controlled trials (RCTs) involving interventions for IUA prevention after transcervical resection of adhesions (TCRA) were included. Outcomes included IUA recurrence rate, AFS score reduction, AFS score and clinical pregnancy rate. Twenty‑six studies (3040 patients) were included. Intrauterine estrogen releasing system showed the highest probability of being the best intervention for IUA recurrence rate (SUCRA: 95.40%) and was superior to IUD (OR for IUD vs. system = 5.35, 95% CI 1.08–26.50). PRF showed the highest probability of being the best intervention for clinical pregnancy rate (SUCRA: 85.42%) and was superior to control (OR for control vs. PRF = 0.20, 95% CI 0.05–0.83) and IUD (OR for IUD vs. PRF = 0.16, 95% CI 0.03–0.80). IUD + balloon ranked highest for AFS reduction (SUCRA: 98.68%), while PRP + balloon ranked highest for AFS score (SUCRA: 85.82%). Substantial heterogeneity was observed for both AFS reduction (I 2 = 90%) and AFS score (I 2 = 99.6%), warranting cautious interpretation. No publication bias was detected. Intrauterine estrogen‑releasing system and IUD + balloon showed promising results for IUA recurrence, while PRF showed potential efficacy for postoperative pregnancy rate, and PRP + Balloon demonstrated the most consistent efficacy across all outcomes. Given substantial heterogeneity and limited evidence, these findings should be considered exploratory and interpreted with caution.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.