Asherman's syndrome surgery
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Editor(s)-in-Chief: C. Michael Gibson, M.S.,M.D. [1] Phone:617-632-7753; Canan S Fornusek, Ph.D.; Associate Editor-In-Chief: M.Umer Tariq [2]
Overview
Surgery
Fertility can be restored by removal of adhesions. Fluoroscopically guided operative hysteroscopy is used for visual inspection of the uterine cavity and dissection of scar tissue (adhesiolysis). In more severe cases, laparoscopy is used in addition to hysteroscopy as a protective measure against uterine perforation. Microscissors are usually used to cut adhesions. Electrocauterization is not recommended [1]. Sometimes a balloon stent (Foley catheter or Cook stent) filled with saline is inserted in the uterus for up to 3 weeks to keep the walls of the uterus apart as they heal to prevent the reformation of adhesions.
Follow-up tests (HSG, hysteroscopy or SHG) are necessary to ensure that scars have not reformed. Further surgery may be necessary to restore a normal uterine cavity.
According to a recent study among 61 patients, the overall rate of adhesion recurrence was 27.9% and in severe cases this was 41.9%. [2] Another study found that postoperative adhesions reoccur in close to 50% of severe Asherman's and in 21.6% of moederate cases [3]. Mild IUA unlike moderate to severe synechiae do not appear to reform.
References
- ↑ Kodaman PH, Arici AA. (2007). "Intra-uterine adhesions and fertility outcome: how to optimize success?". Curr Opin Obstet Gynecol. 19 (3): 207–214. PMID 17495635.
- ↑ Yu D, Li T, Xia E, Huang X, Peng X. (2008). "Factors affecting reproductive outcome of hysteroscopic adhesiolysis for Asherman's syndrome". Fertility and Sterility. 89 (3): 715–722. doi:10.1016/j.fertnstert.2007.03.070. PMID 17681324.
- ↑ Valle RF, Sciarra JJ. Intrauterine adhesions: hysteroscopic diagnosis, classification, treatment, and reproductive outcome. Am J Obstet Gynecol 1988; 158:1459-1470.