Abstract
Objective To compare the effect of intrauterine suitable balloon (ISB) and Foley balloon (FB) in the prevention of adhesion after hysteroscopic adhesiolysis in patients with intrauterine adhesions (IUAs). Methods A retrospective study was conducted on 150 women with moderate and severe IUAs, who underwent hysteroscopic adhesiolysis. According to the postoperative placement of the ISB or FB, the cohort was divided into the ISB group and the FB group. A second-look hysteroscopy was performed at 3 months postsurgery. The scoring system proposed by the American Fertility Society (AFS) was used to evaluate the adhesion during hysteroscopy. Subgroup analysis was carried out based on the degree of IUAs. Results (1) In the ISB group, only 25% (19/76) women presented adhesion reformation after surgery, while, in the FB group, the adhesion reformation was observed in 35.1% (26/74) patients; however, the difference was not statistically significant (P>0.05). Subsequently, the adhesion reformation rate (29.5%, 13/44) after surgery with an ISB for severe intrauterine adhesions was significantly lower as compared to that (53.6%, 15/28) with FB (P<0.05). (2) In the ISB group, the reduction in the adhesion score after surgery was 8 points, which was significantly higher than the 7 points in the FB group (P<0.05). Conclusion The ISB is better than the FB in preventing the adhesion reformation and reducing the AFS score after hysteroscopic adhesiolysis in severe IUAs. Also, it can effectively prevent the adhesion reformation in severe IUAs with a similar effect on moderate IUAs.
Highlights
Intrauterine adhesions (IUAs) occur due to the various causes of damage to the basal layer of the endometrium and intramural uterine adhesion that disrupts the uterine anatomy
(1) In the intrauterine suitable balloon (ISB) group, only 25% (19/76) women presented adhesion reformation after surgery, while, in the Foley balloon (FB) group, the adhesion reformation was observed in 35.1% (26/74) patients; the difference was not statistically significant (P>0.05)
The ISB is better than the FB in preventing the adhesion reformation and reducing the American Fertility Society (AFS) score after hysteroscopic adhesiolysis in severe IUAs
Summary
Intrauterine adhesions (IUAs) occur due to the various causes of damage to the basal layer of the endometrium and intramural uterine adhesion that disrupts the uterine anatomy. A series of clinical symptoms, including abnormal menstrual conditions (especially hypomenorrhea and amenorrhea), infertility, recurrent pregnancy loss, and abnormal placental location of placenta implantation or placenta previa are observed [1]. The incidence of IUAs in abnormal menstruation and infertility is 2.8–45.5% [2], which severely affects the menstrual physiology and reproductive function in women. The standard method of treatment of IUAs is transcervical resection of adhesion (TCRA), wherein the high recurrence rate of postoperative adhesion is the primary challenge. In the case of patients with severe IUAs, the recurrence rate of postoperative adhesions is up to 62.5% [1]. Several auxiliary measures prevent the recurrence of adhesion after TCRA, including physical barriers, biogel, estrogen, and amniotic membrane. A universally recognized effective standard preventive strategy is yet lacking [3, 4]
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