Hellebrekers 2009.

Study characteristics
Methods	Truly randomised trial (computer‐generated schema) Time of randomisation: at scheduling of surgery Blinding: single‐blind Power calculation: no ITT: no Location: sIngle centre—Leiden University Medical Centre Timing and duration: not stated
Participants	women 18 years of age or older who were candidates for open abdominal myomectomy with tubes and ovaries present bilaterally. All women were menstruating regularly, none had received hormonal treatment for at least 2 months before surgery. Good general health with no significant systemic conditions (N = 26) Indication for surgery: clinical indications for myomectomy not stated Number undergoing second‐look laparoscopy: 25 Timing second‐look laparoscopy: 8th postoperative day Exclusion criteria: pregnancy, haematological disorder, or coagulopathy, cancer therapy, unavailable for study duration, ongoing pelvic infection, participation in other clinical investigations, diabetes mellitus
Interventions	300 mL Ringer's lactate with 1 mg reteplase versus 300 mL Ringer's lactate alone Instillation of agent after completion of myomectomy
Outcomes	Scoring of adhesions: Incidence—number of adhesions adherent to uterus or surrounding tissues Severity—defined as adhesion tenacity score (0 to 3) Extent—area covered by adhesions in cm² Adverse effects: defined as undesirable physical, psychological, or behavioural effects experienced by women
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer‐generated randomisation
Allocation concealment (selection bias)	Unclear risk	No comments regarding allocation concealment—insufficient information to allow judgement
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Quote: "Same two gynaecologists performed the second‐look laparoscopy and were blinded to the randomisation during both surgical procedures". Not clearly stated whether women blinded to allocation.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Quote: "The surgeon calculated adhesion scores immediately after surgery. Photographs were taken during myomectomy and videotapes were recorded during early second‐look laparoscopy. A single independent and blinded observer reviewed the photographs and videotapes and made new adhesion scores. These adhesion scores were then compared with the scores from the case record forms made by the two surgeons to ensure consistency of adhesion scoring"
Incomplete outcome data (attrition bias) All outcomes	Low risk	1 participant refused consent for second‐look laparoscopy. No other missing outcome data
Selective reporting (reporting bias)	Unclear risk	Data presented in full for all outcomes specified, however, no study protocol or trial registry identified for comparison
Other bias	Low risk