Querleu 1989.

Study characteristics
Methods	Truly randomised trial Double‐blinded (known by correspondence with study author) Power calculation: no Intention‐to‐treat analysis: yes Randomised trial: method not stated Time of randomisation: evening before surgery Factorial design Power calculation done Location: multi‐centre—5 centres in France (Clermond‐Ferrand, Montpellier, Paris, Roubaix, and Lyon) and 1 centre in the Netherlands (Nijmegen) Timing and duration: 1984 Sponsored by Laboratories Chanterau, France
Participants	Infertile women undergoing open gynaecological microsurgery Condition: distal tubal obstruction,pelvic adhesions, or both (active PID, endometriosis, proximal tubal obstruction cases excluded) Surgery performed: tubal surgery; adhesiolysis (19) Pre‐existing adhesions: analysis done according to pre‐existing adhesion status, but number not stated Age: not stated Duration infertility: not stated Infertility work‐up: not stated Number randomly assigned: 131 5 lost to follow‐up Number analysed: 126 Number undergoing second‐look laparoscopy: 88 Timing second‐look laparoscopy: 3 to 6 months postoperative Blinding at second‐look laparoscopy: not stated
Interventions	Auto‐cross‐linked hyaluronic acid versus no treatment Time of application: end of the procedure Second‐look laparoscopy performed: 60 to 90 days after primary procedure 1. Steroids versus no steroids Route of administration: systemic (IM) Dosage/volume: dexamethasone 2 mg day before surgery, 8 mg day of surgery and day after, 2 mg on following 5 days 2. Noxytioline versus no treatment Route of administration: intraperitoneal Dosage/volume: noxytioline (Noxyflex) 5 mg diluted in 250 mL normal saline instilled in the pelvis via a removable drain Other adjuvants: perioperative pelvic irrigation with heparinised (5000 IU/L) normal saline Prophylactic antibiotics: yes (doxycycline)
Outcomes	Analysed in review Pregnancy Method of diagnosis: not specified Duration follow‐up: 36 months Ectopic pregnancy rate Adhesions at second‐look laparoscopy Improvement; deterioration or no change Change in score Other outcomes Adhesions at second‐look laparoscopy Change in score according to initial score Change in score according to grade of adhesions Change in score in subgroup of pure adhesiolysis Grade of adhesions Per cent of ovarian surface free of adhesions Fimbrial status Mobility of the tube
Notes	Adhesion scoring system used Modified American Fertility Society endometriosis scoring system (range 0 to 84) Adhesions graded as filmy, vascular, or dense Power calculation envisaged participation of 10 centres, entering 32 women each Only 4 centres reached this number; 2 more centres entered fewer women Pregnancy rates also presented in a cumulative conception curve, using life‐table analysis for steroid and no‐treatment groups
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Not stated
Allocation concealment (selection bias)	Unclear risk	Not stated
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Stated that study was double‐blinded, but no further information regarding blinding provided
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Insufficient information to permit judgement
Incomplete outcome data (attrition bias) All outcomes	Low risk	All women accounted for
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	Did not recruit enough women to power study as intended