Post-surgical adhesions are common and can cause substantial co-morbidity. The aim of this review was to investigate the efficacy of 4 % icodextrin solution, a widely used adhesion prevention agent, in gynaecological surgery. Randomised-controlled trials comparing the use of 4 % icodextrin solution vs. Ringer’s-lactated saline (control) in women of any age undergoing fertility-conserving surgery either by laparoscopy or laparotomy were searched and meta-analysis performed. Compared to Ringer’s-lactated saline, there was no significant difference in the number of patients free from de novo adhesions at second-look laparoscopy (SLL) (odds ratio, 1.21 [0.76, 1.93]), the adhesion score reduction at SLL (mean difference (MD), 0.71 [−0.66, 2.08]), the percentage reduction in adhesion extent (MD, 5.47 [−4.18, 15.12]) or severity (MD, 13.49 [−23.78, 50.75]). The included studies reported the effect of 4 % icodextrin in different ways thus limiting meta-analysis. This is the first meta-analysis of icodextrin and the lack of evidence found to support the use of icodextrin suggests further research is required which should be presented in a uniform manner.