Safety and Tolerability of Office Hysteroscopic Adhesiolysis for Asherman's Syndrome

Abstract

Study Objective The primary objective of our study was to assess the proportion of patients who successfully tolerated a primary office-based hysteroscopic lysis adhesions (LOA). Additionally, we assessed the incidence of procedural adverse events associated with office-based hysteroscopic LOA and adjusted for both March classification severity and utilization of ultrasound guidance. Design A retrospective chart review of patients who underwent hysteroscopic LOA during their evaluation and management for Asherman's syndrome. Setting A community teaching hospital. Patients or Participants 355 Asherman's syndrome patients who underwent hysteroscopic LOA from 01/01/2015 to 03/01/2019. Interventions Hysteroscopic adhesiolysis. Measurements and Main Results The 355 Asherman's syndrome patients underwent a total of 813 hysteroscopic LOA (primary and follow-up) at our institution during the study period. The mean number of hysteroscopic procedures performed for all patients in this time period was 2.3 ± 1.5 procedures per patient. When assessed by March classification, mild severity patients underwent 1.5 ± 1.0 procedures/patient, moderate severity underwent 2.8 ± 1.4 procedures/patient, and severe severity underwent 3.3 ± 1.9 procedures/patient. Of the 335 primary hysteroscopies, 93.5% (332 cases) were performed within the office, and 92.8% (308 patients) of these procedures were well tolerated and without any adverse events. Adverse events amongst primary office-based hysteroscopic LOA included 6.3% (21 cases) incomplete procedures due to patient intolerance, 0.6% (2 patients) false passage creation and 0.3% (1 patient) uterine perforation. Multivariable logistic regression analyses were performed and determined that March classification and utilization of ultrasound guidance were not directly associated with adverse events. Conclusion Hysteroscopy in the office is well tolerated and able to be completed safely in patients who have a diagnosis of Asherman's Syndrome which suggests more operative hysteroscopic should be attempted in the office rather than the operating room.