Effect of Surgicel Application on Adhesion Formation to the Uterine Scar Following Cesarean Section

Background: Post-cesarean adhesions are a major cause of operative difficulty, pelvic pain, and infertility. Surgicel (oxidized regenerated cellulose) is frequently used for intraoperative hemostasis, but its role in adhesion formation remains controversial. Objective: To assess the effect of Surgicel application on the incidence and severity of postoperative adhesions at the uterine scar after cesarean section. Methods: A prospective cohort study was conducted at Saudi National Hospital, Makkah, between January and October 2024. Sixty women undergoing cesarean section were enrolled—30 received Surgicel on the uterine incision (Surgicel group), and 30 underwent standard closure (control). Adhesion formation was evaluated at follow-up surgery or imaging ≥6 months postoperatively using the modified Nair Adhesion Scoring System. Results: Adhesions were observed in 66.7% of the Surgicel group versus 33.3% of controls (p = 0.01). The mean adhesion extent (35% vs. 18%) and tenacity score (3.5 vs. 2.1) were significantly higher with Surgicel. Omental adhesions were the most common type observed. Conclusion: Surgicel, although effective for hemostasis, may increase postoperative adhesion formation at the uterine scar. Surgeons should balance hemostatic benefit against adhesion risk during cesarean section.