Early Second-Look Hysteroscopy: Prevention and Treatment of Intrauterine Post-surgical Adhesions.

Lauren Sebbag,Jean-Marc Ayoubi,Marie Carbonnel,Dominique De Ziegler,Stéphanie Fay,Paul Pirtea,Aurélie Revaux,Iptissem Naoura,Marc Even

doi:10.3389/fsurg.2019.00050

Abstract

Introduction: Intra-uterine adhesion (IUA) is one of the main causes of secondary infertility. The aim of this study was to evaluate the prevalence of IUA developing in women undergoing hysteroscopic resection for submucous myomas, polyps, and intrauterine synechiae and test the efficacy of second look hysteroscopy for diagnosing and treating post-surgical adhesions.Materials and Methods: We retrospectively collected data from reproductive age women who had a second look office hysteroscopy following hysteroscopic resection for myoma, polyp, or IUA at Foch hospital (Suresnes, France) between 2009 and 2017.Results: Six hundred and twenty two reproductive-age women underwent hysteroscopic resection for myoma, polyp, and/or IUA. Among them, 155 women had a second look hysteroscopy. In this group, 29/155 (18.7%) had IUA formation: 17/83 (20.5%) women who underwent hysteroscopic myomectomy, 5/46 (10.9%) women who underwent hysteroscopic polypectomy, and 7/26 (26.9%) women who underwent hysteroscopic lysis of adhesions. These IUA have been lysed by the office hysteroscopy procedure in 16/29 (55.2%) patients: 11/17 (64.7%), 2/5 (40%), and 3/7 (42.9%) in women who underwent hysteroscopic myomectomy, polypectomy and lysis of adhesion, respectively.Conclusion: IUA is a common complication of hysteroscopic surgery. Second look office hysteroscopy is an easy and effective procedure for diagnosing and removing newly formed IUA. It should be recommended for all women undergoing hysteroscopic resection for myomas, polyps, or IUA.

Highlights

Intra-uterine adhesion (IUA) is one of the main causes of secondary infertility
In the remaining cases (63/155) the post-surgical hysteroscopy was performed for other indications [infertility investigation, pre-IVF, atypical endometrial hyperplasia (AEH), dysfunctional uterine bleeding] with an average time interval of 47.4 weeks after the original surgery
The current study shows that IUA is a common finding following hysteroscopic surgery, with an incidence of 18.7% found at second look hysteroscopy

Summary

Introduction

Intra-uterine adhesion (IUA) is one of the main causes of secondary infertility. The aim of this study was to evaluate the prevalence of IUA developing in women undergoing hysteroscopic resection for submucous myomas, polyps, and intrauterine synechiae and test the efficacy of second look hysteroscopy for diagnosing and treating post-surgical adhesions. Intra-uterine adhesion (IUA) is an inflammatory reaction linking the opposed uterine walls. It most commonly occurs after traumas to the basalis layer of the endometrium most frequently, after curettage, cesarean sections, post-partum hemorrhage, abdominal myomectomy, and/or hysteroscopic resections of myoma, polyp, or uterine septum [2, 3]. IUA is one of the main cause of secondary infertility with an incidence of 1.7–7% seen when hysteroscopies are performed in infertile women [4]. IUA can be classified in three stages, according to the American Fertility Society (AFS): mild (grade I), moderate (grade II), and severe (grade III) [12]

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