2. Oxidised Regenerated Cellulose versus No Treatment at Laporoscopy for adhesion prevention after gynaecological surgery.

Oxidised Regenerated Cellulose versus No Treatment at Laporoscopy for adhesion prevention after gynaecological surgery (Ahmad 2014(a))
Patient or population: Women undergoing laparoscopy Settings: Gynaecological surgery Intervention: Oxidised Regenerated Cellulose versus No Treatment at Laparoscopy
Outcomes	Illustrative comparative risks* (95% CI)		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	No treatment	Oxidised Regenerated Cellulose
Pelvic Pain						Not Reported
Pregnancy Rate						Not Reported
Live Birth Rate						Not Reported
Quality of Life						Not Reported
Incidence of adhesions ‐ De novo Follow‐up: 2‐14 weeks	333 per 1000	200 per 1000 (130 to 290)	OR 0.5 (0.3 to 0.83)	360 (3 studies)	⊕⊝⊝⊝ very low1,2,3
Incidence of adhesions ‐ Reformation (or mixture) Follow‐up: 8‐30 weeks	700 per 1000	284 per 1000 (140 to 489)	OR 0.16 (0.07 to 0.41)	100 (3 studies)	⊕⊕⊝⊝ low3,4
*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; OR: Odds ratio;
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
1 One of three studies was at unclear risk of selection bias and one of three studies was at unclear risk of allocation bias. One of three studies was also deemed to be at high risk of attrition bias, with the other two studies having an unclear risk. All three studies were at unclear risk for reporting bias, performance bias and detection bias. Therefore, the quality of the result was downgraded. 2 Heterogeneity evident as I2 value was 85%, there was poor overlap of confidence intervals on visual examination and Chi2 p‐value was <0.05. The reason for the heterogeneity was likely due to differences in the methods (such as the different follow up times, and the different types of surgery that participants had to undergo) 3 There was potential publication bias, with Ahmad 2014(a) reporting that there was evidence of duplicate publication data and the existence of unreported data. The specific evidence for this was not detailed in the paper, though they do state that they had contacted the initial authors. 4 Two of the three trials were deemed to be at high risk of randomisation bias, one trial was deemed to be high risk of allocation concealment bias, while one trial was at unclear risk. Finally, one trial was deemed high risk of attrition bias, while the other two trials were at unclear risk of attrition bias. The evidence was therefore downgraded.