Reduction of adhesions after uterine myomectomy by Seprafilm membrane (HAL-F): A blinded, prospective, randomized, multicenter clinical study

Objective: To assess the safety and efficacy of Seprafilm (HAL-F), Bioresorbable Membrane, (Genzyme Corporation, Cambridge, MA) in reducing the incidence, severity, extent, and area of uterine adhesions after myomectomy. Design: Prospective, randomized, blinded, multicenter study. Adhesion reduction was assessed by an independent, blinded, gynecologic surgeon who reviewed videotapes of each patient's second-look laparoscopy. Setting: Nineteen institutions across the United States. Patient(s): One hundred twenty-seven women undergoing uterine myomectomy with at least one posterior uterine incision ≤ 1 cm in length. Intervention(s): Patients were randomized to treatment with Seprafilm or to no treatment at the completion of the myomectomy. Main Outcome Measure(s): The incidence, severity, extent, and area of uterine adhesions at second-look laparoscopy. Result(s): The incidence, measured as the mean number of sites adherent to the uterine surface, was significantly less in treated patients (4.98 ± 0.52 [mean ± SEM] sites) than in no treatment patients (7.88 ± 0.48 sites) as were the mean uterine adhesion severity scores (1.94 ± 0.14 versus 2.43 ± 0.10; treatment versus no treatment, respectively), mean extent scores (1.23 ± 0.12 versus 1.68 ± 0.10), and mean area of adhesions (13.2 ± 1.67 versus 18.7 ± 1.66 cm²). No adverse events occurred that were judged to be related to the use of Seprafilm. Conclusion(s): In this multicenter study, treatment of patients after myomectomy with Seprafilm significantly reduced the incidence, severity, extent, and area of postoperative uterine adhesions. Additionally, Seprafilm treatment was not associated with an increase in postoperative complications.