GynecologyGynecology2079-56962079-5831Consilium Medicum3349710.26442/20795696.2019.2.190360Research ArticleThe effectiveness of anti-adhesive barrier based on carboxymethylcellulose 5 mg and sodium hyaluronate 2.5 mg in various methods of surgical treatment of ectopic tubal pregnancyFitishevaLarisa EGraduate Studentalex-fl2018@yandex.ruMozesVadim GD. Sci. (Med.)-ZaharovIgor SD. Sci. (Med.)-MozesKira BАssistant-Kemerovo State Medical University15042019212717516042020Copyright © 2019, Consilium Medicum2019Aim. To evaluate the effectiveness of the anti-adhesive barrier in the form of a gel based on carboxymethylcellulose 5 mg and sodium hyaluronate 2.5 mg with various techniques of surgical treatment of ectopic tubal pregnancy. Materials and methods. A randomized study was conducted on 98 women who underwent laparoscopic resection of the ampulla of the fallopian tube, together with a embryo, followed by neostomatoplasty or salpingostomy with or without an anti-adhesive barrier. The primary outcome of the study was the incidence of uterine pregnancy and its outcomes at 18 months of follow-up; secondary outcomes were the frequency of adhesions in the pelvis, the frequency of patency of the operated fallopian tube according to second look laparoscopy with chromohydrotubation by 3 months of follow-up. Results. At 3 months of follow-up, the use of an anti-adhesion barrier reduced the incidence of postoperative adhesions in the area of the operated fallopian tube and the degree of adhesions in the pelvis; increased the frequency of patency of the operated fallopian tube when performing laparoscopic resection of a portion of the ampulla of the fallopian tube, followed by neostomatoplasty. By the 18th month of observation, no statistically significant difference in the incidence of spontaneous pregnancy and its outcomes in the studied women was detected. Conclusion. Use of 5 mg carboxymethylcellulose and 2.5 mg sodium hyaluronate anti-adhesive barrier with various organ-preserving methods of surgical treatment of ectopic tubal pregnancy reduces the frequency and extent of postoperative adhesions in the area of the operated fallopian tube, in the small pelvis, but does not increase fertility in the postoperative period.ectopic pregnancyanti-adhesive barrierpostoperative adhesive processfertilityэктопическая беременностьпротивоспаечный барьерпослеоперационный спаечный процессфертильность[Femke M, Annika S, Davor J et al. The ESEP study: Salpingostomy versus salpingectomy for tubal ectopic pregnancy. The impact on future fertility: A randomised controlled trial. Womens Health 2008; 8: 11.][Jingwei L, Kailei J, Fujie Z. Fertility outcome analysis after surgical management of tubal ectopic pregnancy: a retrospective cohort study. BMJ Open 2015; 5: 9.][Dijkstra F.R, Nieuwenhuijzen M. Recent clinical developments in pathophysiology, epidemiology, diagnosis and treatment of intra-abdominal adhesions. Scand J Gastroenterol 2000; (Suppl. 232): 52-9.][Tsaousi G, Stavrou G, Fotiadis K et al. Implementation of phospholipids as pharmacological modalities for postoperative adhesions prevention. Eur J Pharmacol 2019;842: 189-96.][Broek R, Stommel M, Stirk C et al. Benefits and harms of adhesion barriers for abdominal surgery: a systematic review and meta-analysis. Lancet 2014; 383 (9911): 48-59.][Фетищева Л.Е., Мозес В.Г., Захаров И.С. Эффективность резекции части ампулярного отдела маточной трубы с плодным яйцом и последующей неостоматопластикой при внематочной беременности в сохранении фертильности. Фундаментальная и клин. медицина. 2018; 1: 42-50.][Wang W, Li R, Fang T et al. Endometriosis fertility index score maybe more accurate for predicting the outcomes of in vitro fertilisation than r-AFS classification in women with endometriosis. Reprod Biol Endocrinol 2013; 11: 112.][Moris D, Chakedis J, Rahnemai-Azar A.A et al. Postoperative Abdominal Adhesions: Clinical Significance and Advances in Prevention and Management. J Gastrointest Surg 2017; 21 (10): 1713-22.][Tanaka K, Hashimoto H, Misawa T, Akiba T. The Prevention of Carboxymethylcellulose on Bowel Adhesions Induced by Talc Peritonitis in Mice. J Surg Res 2019; 234: 311-6.][Zhao J.M, Jin Z.Z, Zhao Q.Z. The preventive effect of ambroxol hydrochloride chitosan on postoperative intraperitoneal adhesion formation in a rat model. Acta Chir Belg 2017; 117 (4): 232-7.][Ahmad G, Mackie F.L, Iles D.A et al. Fluid and pharmacological agents for adhesion prevention after gynaecological surgery. Cochrane Database Syst Rev 2014; 7: CD001298. DOI: 10.1002/14651858. CD001298.pub4][Ahmad G, O'Flynn H, Hindocha A, Watson A. Barrier agents for adhesion prevention after gynaecological surgery. Cochrane Database Syst Rev 2015; 4: CD000475. DOI: 10.1002/14651858.CD000475.pub3][Pados G, Venetis C.A, Almaloglou K, Tarlatzis B.C. Prevention of intra-peritoneal adhesions in gynaecological surgery: theory and evidence. Reprod Biomed Online 2010; 21 (3): 290-303.]