Hysteroscopic myomectomy for menorrhagia using Versascope™ bipolar system: Efficacy and prognostic factors at a minimum of one year follow up

Objective

To evaluate the effectiveness of hysteroscopic submucous myomectomy for women with heavy menstrual bleeding (HMB) over a minimum 1-year period and assess prognostic factors associated with treatment success.

Study design

Prospective observational study set in a university teaching hospital in UK involving 92 women symptomatic of HMB with submucous myomas consecutively recruited between June 2003 and November 2006. Hysteroscopic myomectomy was performed under outpatient local anaesthetic (n = 35, 38%) or daycase general anaesthesia (n = 57, 62%) using Gynecare Versascope™ bipolar system. The main outcome measures were: the need for secondary surgical or medical re-intervention, menstrual improvement and patient satisfaction. Other outcome measures include: successful completion of primary resection, type of secondary treatment.

Result

Mean follow up was 2.6 years (95% CI 2.3–2.9). Complete fibroid excision was achieved in 66%. Secondary surgical re-intervention was required in 27 (29%) of which 11 (12%) were repeat hysteroscopic myomectomy and 10 (11%) were hysterectomy procedures. Multiple uterine fibroids and adenomyosis were identified in 80% of hysterectomies. At follow up, improved menstrual symptoms and patient satisfaction were reported by 91% and 86%, respectively. Irregular cycle HMB and incomplete fibroid excision were associated with secondary retreatment. Size of the submucous fibroid resected, presence of intramural and subserosal fibroids, or LA vs. GA setting were unrelated to treatment success.

Conclusion

HMB with submucous myomas may be successfully treated by completely removing the intracavity myoma component, irrespective of co-existent intramural or subserosal fibroids or size of fibroid resected. This effect remains sustained over at least a 1–2 year period.     

A novel modification of conventional laparoscopic myomectomy using manual assistance for multiple uterine myomas

Objectives

To evaluate the efficacy and feasibility of finger-assisted laparoscopic myomectomy for multiple myomas.

Study design

A total of 565 patients with symptomatic myomas underwent finger-assisted laparoscopic myomectomy between January 2006 and March 2011 to remove multiple myomas at our center. Laparoscopic myomectomy technique was modified, and involved the insertion of two fingers into the vagina to elevate the uterus, while one or two fingers of the other hand were inserted into the abdomen through a suprapubic 15-mm trocar port for palpation of small myomas, which did not distort the uterine contour.

Results

The mean (SD; range) patient age was 38.26 years (5.84; 25–48 years). The diameter of the largest myoma in each case was 6.13 cm (1.21; 4–15 cm). The total number of myomas enucleated in the initial enucleation was 2228. There were 597 additional myomas enucleated with finger-assisted guidance. The mean diameter of the additionally enucleated myomas was 1.1 cm (range, 0.2–2.5 cm), which was significantly smaller than those of the initially enucleated myomas (p = 0.002). The mean operative time was 97.1 min (30.2; 35–180 min). The decrease in postoperative hemoglobin concentration was 1.6 g/dL (0.7; 0.4–3.2 g/dL). During the operation, no patients required a blood transfusion. Six patients developed postoperative fever. There was no occurrence of bowel or urinary tract injury. The mean postoperative hospital stay was 3.2 days (0.9; 2–6 d). All procedures were successfully completed without the need for laparotomy.

Conclusions

Finger-assisted laparoscopic myomectomy is a feasible and safe approach in the surgical treatment of multiple myomas.     

Factors associated with operative hysteroscopy outcome in patients with uterine adhesions or submucosal myomas

Objective

To determine the factors associated with hysteroscopic surgery long-term outcome in patients with intrauterine adhesions or submucosal myomas.

Methods

Factors thought to be associated with outcome were retrospectively evaluated from the records of 591 patients who were followed up for at least 5 years after undergoing hysteroscopic adhesiolysis (n = 203) or myomectomy (n = 388).

Results

The major factors affecting outcome were degree of adhesion (OR, 1.91; P = 0.03) in the former group and parity (OR, 0.55; P = 0.005) and depth of intramural penetration of the myoma (OR, 30.74; P < 0.001) in the latter. Severe intrauterine adhesion, low parity, and deep intramural penetration of submucosal myoma had an associated increase risk of poor outcome. The overall complication rate was 1.35% and, respectively, 12.8% and 9.3% of the patients who underwent hysteroscopic adhesiolysis or myomectomy needed a second intervention.

Conclusion

Hysteroscopic surgery is a safe and effective procedure. Degree of adhesion or parity and depth of intramural penetration of myomas are the major factors affecting outcome in patients with these lesions.     

Fertility rates after hysteroscopic treatment of submucous myomas depending on their type

The objective was too evaluate the pregnancy rate and the chance of term pregnancy following hysteroscopic myomectomy depending on the type of the myoma. Between February 2000 and October 2005, a total of 25 patients under 36 years of age (mean 30.1±5.8 SD) with a diagnosis of primary or secondary infertility and menstrual disorders due to submucous myoma underwent hysteroscopic myomectomy. The subgroups of the patients depending on the type of the myomas were: Type 0, 14 patients; type I, 7 patients; and type II, 4 patients. For the subgroup of patients with type II myomas there was a control group of 8 patients with infertility but without menstrual disorders who did not consent to undergoing operative hysteroscopic treatment and received expectant management. Mean myoma size was 22.6±14.7 mm, mean duration of the procedure was 28±17 min, and mean follow-up was 18±12.5 months. Menstrual pattern was reestablished in 84% of patients. Hysteroscopic myomectomy was associated with an increase in pregnancy rate: 57.1% for patients with type 0 myoma and 42.8% for patients with type I myoma. Patients with type II myoma, after hysteroscopic myomectomy, had a 25% pregnancy rate, while patients who received expectant management had a 50% rate. Delivery at term was achieved by 35.7% of patients with type 0 myoma, by 28.5% of patients with type I myoma, and by 25% of patients with type II myoma, after hysteroscopic myomectomy. Patients with type II myoma without menstrual disorders had a 37.5% term delivery rate receiving expectant management. Three patients had a spontaneous abortion during the first trimester (12%) and one patient had premature labor at 34 weeks’ gestation (4%). Fertility rates appear to increase after hysteroscopic myomectomy of type 0 and type I myomas in previously infertile patients. In patients with type II myomas fertility rates did not increase, in contrast with patients with type II myomas who received expectant management. No difference in fertility rates was observed between patients with different types of submucous myomas after myomectomy, while the complication rate for these procedures is low. Patients’ age and type of infertility (primary or secondary) are factors that do not affect fertility rates after hysteroscopic myomectomy.

Early-stage morphological observations of myoma and myometrium after laparoscopic uterine artery occlusion treatment

Objective

Myoma therapy by uterine artery occlusion using laparoscopic ligation (UAOL) has been performed for many years and has proven effective, but limited information is available on its therapeutic mechanism. To examine this issue, we conducted this study to investigate the morphological change and apoptosis occurring in myomal and adjacent myometrial tissues shortly after UAOL.

Study design

In total, 16 myomas and adjacent myometrium were obtained from 7 cases before and at various points after artery ligation. The tissues were stained using hematoxylin and eosin for morphological observation. To investigate the existence of apoptosis, in situ immunostaining of Caspase 3 and TUNEL assay were performed. Cytochrome C released from mitochondria was also detected by immunohistochemistry.

Results

Microscopic observation found that after UAOL, both myometrial and myomal tissues were edematous and apoptotic cells were widespread in both tissues. TUNEL assays showed that before UAOL, numbers of apoptotic cells in myomal and myometrial tissues had no significant differences (P = 0.866). After ischemia of (36.69 ± 18.53) min, apoptosis was significantly more elevated in myoma than in myometrium ((6.43 ± 4.38)/10 HPF vs. (2.74 ± 1.95)/10 HPF, P = 0.003). Caspase 3 stain shared similar features with the TUNEL assay. In both groups cytochrome C was released from mitochondria after UAOL, and more was detected in the myoma.

Conclusion

UAOL is an alternative method to treat symptomatic uterine myomas. Apoptosis via mitochondrial pathways may lead to reduction of the volume of myoma and myometrium and eventual relief of symptoms.     

A new system to classify submucous myomas: a brazilian multicenter study

ObjectiveTo evaluate 2 different predicting scores of submucous myoma removal, fluid balance, and operative time in woman undergoing hysteroscopic myomectomy.DesignA multicenter and prospective study (Canadian Task Force classification II-2).SettingSix hysteroscopy centers in Brazil.PatientsA total of 191 women who underwent hysteroscopic resection of 205 submucous myomas.InterventionResection of submucous myomas (hysteroscopic myomectomy). Myomas were scored according to the European Society for Gynaecological Endoscopy (ESGE) and STEPW (size, topography, extension, penetration, and wall) classifications. The validation of the 2 classifications was assessed with sensitivity and specificity of each classification, with their best cutoff point.Main Outcome MeasuresTo correlate ESGE and STEPW classifications with complete or incomplete removal of submucous myoma, length of surgery, surgical complications, and fluid balance.ResultsRemoval of the myoma was complete in 190 (92.7%) of 205 myomectomies, and incomplete in 15 (7.3%). All 140 (100%) of 140 myomas with a score ≤4 in the STEPW classification were completely removed, and 50 (76.9%) of 65 myomas with a score >4 were removed. All 15 (100%) cases of incomplete hysteroscopic myomectomy had a STEPW score >4. With the ESGE classification, 156/164 (95.1%) cases of type 0 and type 1 myomas, and 34/41 (82.9%) of type 2 were completely resected. STEPW scores >4 were statistically associated with longer duration of surgery, surgical complications, higher levels of fluid balance, and use of gonadotropin releasing hormone analogue if compared with lower scores. The ESGE scores were not associated with any of these variables.ConclusionClassifying submucous myomas with the STEPW classification allows better prediction of myoma removal, fluid balance, length of surgery and surgical complications in hysteroscopic myomectomy than ESGE classification.     

Intraoperative Effect of Preoperative Gonadotropin-Releasing Hormone Analogue Administration in Women Undergoing Cold Loop Hysteroscopic Myomectomy: A Randomized Controlled Trial

Study Objective

To evaluate the intraoperative effects of gonadotropin-releasing hormone (GnRH) analogue pretreatment in patients undergoing cold loop hysteroscopic myomectomy.

A Multicenter Study Evaluating the Effect of Ulipristal Acetate during Myomectomy

Study Objective

To compare surgical experience at myomectomy between patients with myomas pretreated with ulipristal acetate versus no pretreatment.

Laparoscopic radiofrequency volumetric thermal ablation of fibroids versus laparoscopic myomectomy

Objective

To compare the mean hospital discharge times and perioperative outcomes for radiofrequency volumetric thermal ablation (RFVTA) of fibroids and laparoscopic myomectomy (LM).

Methods

The present postmarket, randomized, prospective, single-center, longitudinal, comparative study, conducted in Tübingen, Germany, evaluated the outcomes of RFVTA and the current standard of care (LM) for symptomatic uterine fibroids in women who desired uterine conservation. The surgeons were blinded to the treatment until all fibroids had been mapped by laparoscopic ultrasound.

Results

The mean hospitalization times were 10.0 ± 5.5 (median 7.8 [range 4.2–25.5]) hours for the RFVTA group and 29.9 ± 14.2 (median 22.6 [range 16.1–68.1]) hours for the LM group (P < 0.001, Wilcoxon test). Intraoperative blood loss was 16 ± 9 (median 20 [range: 0–30]) mL for the RFVTA procedures and 51 ± 57 (median 35 [range 10–300]) mL for the LM procedures. The percentage of fibroids imaged by laparoscopic ultrasound that were treated/excised was 98.6% for RFVTA and 80.3% for LM. Two complications were reported: vertigo (n = 1; RFVTA) and port site hematoma (n = 1; LM).

Conclusion

Radiofrequency volumetric thermal ablation resulted in the treatment of more fibroids, a significantly shorter hospital stay, and less intraoperative blood loss than laparoscopic myomectomy.ClinicalTrials.gov:NCT01750008     

HER2/neu gene amplification determines the sensitivity of uterine serous carcinoma cell lines to AZD8055, a novel dual mTORC1/2 inhibitor

Objective

To evaluate c-erbB2 gene amplification in a series of primary uterine serous carcinoma (USC) cell lines. To assess the efficacy of AZD8055, a novel dual mTORC1/2 inhibitor against primary HER2/neu amplified vs HER2/neu not amplified USC cell lines.

Methods

Twenty-two primary USC cell lines were evaluated for c-erbB2 oncogene amplification by FISH assays. In vitro sensitivity to AZD8055 was evaluated by flow-cytometry-based viability and proliferation assays. Cell cycle profile and downstream cellular responses to AZD8055 were assessed by measuring the DNA content of cells and by phosphorylation of the S6 protein by flow-cytometry.

Results

Nine of 22 (40.9%) USC cell lines demonstrated c-erbB2 gene amplification by FISH. AZD8055 caused a strong differential growth inhibition in USC cell lines, with high HER-2/neu-expressors demonstrating significantly higher sensitivity when compared to low HER-2/neu-expressors (AZD-8055 IC₅₀ mean ± SEM = 0.27 ± 0.05 μM in c-erbB2 amplified versus 1.67 ± 0.68 μM in c-erbB2 not amplified tumors, P = 0.03). AZD8055 growth-inhibition was associated with a significant and dose-dependent increase in the percentage of cells blocked in the G0/G1 cell cycle phase and a dose-dependent decline in pS6 levels in both c-erbB2 amplified vs c-erbB2 not amplified USC cell lines.

Conclusions

AZD8055 may represent a novel targeted therapeutic agent in patients harboring advanced/recurrent/refractory USC. c-erbB2 gene amplification may represent a biomarker to identify USC patients who may benefit most from the use of AZD8055.     

Hysteroscopic metroplasty in patients with a uterine septum and otherwise unexplained infertility

Objective

To evaluate the reproductive outcomes of patients with a uterine septum and otherwise unexplained infertility who underwent hysteroscopic metroplasty, and to compare them with those of patients with the same diagnosis who did not have hysteroscopic metroplasty.

Methods

The present retrospective study included 127 patients with diagnosis of a uterine septum and otherwise unexplained infertility. The reproductive outcomes of 102 patients who underwent hysteroscopic metroplasty (group 1) and 25 patients who rejected the operation (group 2) were compared.

Results

Of the 102 patients who underwent hysteroscopic metroplasty, 44 (43.1%) were able to achieve pregnancy, as compared with 5 (20%) of the 25 patients who did not undergo the operation (P = 0.03). The abortion rate was 11.4% (5/44) in group 1, compared with 60% (3/5) in group 2 (P = 0.02). The live birth rate was 35.3% (36/102) in group 1, as compared with 8% (2/25) in group 2 (P = 0.008).

Conclusions

The results indicate that hysteroscopic metroplasty improves reproductive outcome for patients with a uterine septum and otherwise unexplained infertility.     

Laparoscopic myomectomy in peri- and post-menopausal women is safe, efficacious and associated with long-term patient satisfaction

Objective

Women in the peri- and post-menopause may ask for uterus-preserving therapy options when presenting with benign uterine disorders such as symptomatic fibroids. Laparoscopic myomectomy (LM) for patients in the peri- and post-menopause as a surgical alternative to hysterectomy is widely considered to be non-standard treatment. The aim of this study was to analyze safety and outcome of LM beyond the reproductive period.

Study design

We evaluated the surgical outcome and patient satisfaction for a total of 451 patients: 85 peri- or post-menopausal women as group A and, for reference, 366 premenopausal women in group B, who received LM from 1998 to 2008 in our department. We analyzed data from our medical records and applied a patient questionnaire in September 2009.

Results

The average number of fibroids removed and size of the leading fibroid were similar in both groups. Time of surgery was different in group A, at 102.8 min, compared to group B, 128.6 min (p < 0.01). Rates of intra- (2.21% overall) and post-operative complications (6.22% overall) were comparable for both groups. Post-surgical hospitalization was shorter in group B (4.4 days) compared to group A (5.0 days) (p < 0.01). Evaluation of the questionnaire showed high satisfaction with the results of LM in both subgroups with a significantly lower number of relapses in group A (3.5%) compared to group B (11.2%).

Conclusion

Laparoscopic myomectomy as a surgical treatment option in the peri- and post-menopause was characterized by a low rate of complications and relapses as well as a high degree of patient satisfaction in our analysis.     

Changes in myometrial thickness during hysteroscopic resection of deeply invasive submucous myomas.

STUDY OBJECTIVE: To evaluate the efficacy of hysteroscopy in resecting submucous myomas with deep intramural invasion. DESIGN: Prospective, observational study (Canadian Task Force classification II-2). SETTING: Department of gynecology at a general hospital. PATIENTS: Sixteen women with a solitary submucous myoma, in which myometrial thickness between the outer edge of the myoma and inner edge of the serosa was between 5 and 10 mm. INTERVENTION: One-step hysteroscopic myomectomy. MEASUREMENTS AND MAIN RESULTS: Median myoma diameter and weight were 3.3 cm and 30 g, respectively. Myometrial thickness between the myoma and serosa increased gradually and significantly from 6.7 mm before, to 8.9 mm during, to 16.1 mm immediately after hysteroscopic myomectomy (p <0.001). The thickness of the opposite uterine wall increased from 10.1 mm before, to 11.4 mm during, to 18.8 mm after operation (p <0.001). CONCLUSION: One-step hysteroscopic myomectomy may be performed to remove deeply infiltrating submucous myomas when myometrial thickness at the implantation site is as thin as 5 mm.     

Endometrial polyp size and polyp hyperplasia

Objective

To assess the correlation between the size of endometrial polyps and the histopathologic diagnosis of hyperplasia or cancer.

Methods

A retrospective study was conducted using databases of the outpatient clinic at Antonio Pedro University Hospital in Niterói, Brazil, and of a private hysteroscopy service. The analysis included 1136 asymptomatic patients with an endometrial polyp identified on hysteroscopy, with pathologic examination, during the period 1999–2012. The polyp size, the patients’ age, the indication for hysteroscopic examination, and the use of hormone medication were compared with the finding of hyperplasia in the pathologic examination.

Results

Only polyp size showed statistical significance among the variables analyzed (P < 0.05). Endometrial polyps greater than 15 mm showed a hyperplasia rate of 14.8%, compared with 7.7% in the group with smaller polyps (P < 0.05).

Conclusion

Endometrial polyps measuring more than 15 mm were associated with hyperplasia.     

A randomized,controlled study comparing minilaparotomy versus isobaric gasless laparoscopic assisted minilaparotomy myomectomy for removal of large uterine myomas: Short-term outcomes

Objective

To compare the operative data and early postoperative outcomes for myomectomy performed by minilaparotomy (MLT) with isobaric laparoscopic assisted minilaparotomy myomectomy (LM) in a series of patients with large uterine myomas (≥5 cm) randomly assigned to each surgical technique.

Study design

80 patients were randomized blindly using a computer randomization list to MLT (n = 40) or LM (n = 40).

Results

The mean (±SD) operating time was significantly shorter after LM than after MLT (75.50 ± 25.70 vs 96.00 ± 26.20 min; p < 0.01). Intraoperative blood loss was less with LM (72.15 ± 44.00 vs 96.21 ± 38.50 ml; p < 0.05), and ΔHb was less with LM (1.21 ± 0.55 vs 1.64 ± 0.57; p < 0.05). No intraoperative complications occurred, and no case was returned to the theater in either group. No conversion to standard laparotomy was necessary. Hospitalization was shorter after LM than after MLT (4.30 ± 1.20 vs 6.90 ± 2.70 days; p < 0.01). Postoperative ileus was shorter after LM than after MLT (26.20 ± 4.20 vs 40.50 ± 4.90 h; p < 0.01). The mean VAS score at 12 h for abdominal pain was 5.5 ± 0.7 in the LM group and 5.2 ± 0.8 in MLT group (p < 0.05), whereas it was analogous in the two groups at 24 h, and at 48 h was 3.4 ± 1.1 in the LM group and 4.2 ± 1.1 in the MLT group (p < 0.05), and no difference between two groups was detected in the overall mean (at 12, 24 and 48 h).

Conclusions

Several surgical and immediate postoperative outcomes were significantly better in the LM group than in the MLT group.     

Mifepristona 5 mg frente a 10 mg diarios en el tratamiento del leiomioma. Ensayo clínico aleatorizado

Objective

To estimate the efficacy and safety of 5 mg or 10 mg mifepristone daily in the treatment of leiomyoma.

Material and methods

Ninety women with symptomatic uterine myomas were randomised to receive 5 mg or 10 mg of mifepristone (45 per group). Leiomyomata and uterine volumes were evaluated by ultrasonography. Efficacy was estimated by the reduction of the leiomyomata and uterine volumes and the prevalence of symptoms.

Results

After treatment, in the 5 mg group there was a 60.8%, (P < .001), reduction in the fibroid volume and it was 59.4%, (P < .001), in the 10 mg group. The prevalence of symptoms decreased significantly. After treatment, 93.8% subjects from the 10 mg mifepristone group and 86.4% subjects from the 5 mg group were amenorrheic, respectively.

Conclusions

Both treatments were effective for treating uterine fibroids.     

A case-control study to compare the outcome of women treated by two minimally invasive procedures-ultraminilaparotomy myomectomy and laparoscopic myomectomy

Objective

Ultraminilaparotomy myomectomy (UMLT-M with less 4 cm transverse skin incision) and conventional 3-port wound laparoscopic myomectomy (LM) approaches were proposed as alternative minimally invasive procedures in the management of women with symptomatic uterine myomas but few studies have compared the outcomes of both procedures.

Small uterine septum is an important risk variable for preterm birth

Objective(s)

To evaluate whether a uterus with a small septum (arcuate uterus or class VI according to the American Fertility Society (AFS) classification) behaves similarly to a uterus with a larger septum (septate or subseptate uterus or AFS class V).

Study design

Observational study included 826 singleton deliveries to 730 women with a history of hysteroscopic resection of the uterine septum. Data on deliveries were obtained from the National Perinatal Registry of Slovenia (NPIS). Multiple gestations were excluded. We analysed and compared perinatal outcomes before and after hysteroscopic resection in two groups of women: in women with a small uterine septum (Group A) and in those with a larger uterine septum (Group B). Data on the septum length were obtained during hysteroscopic resection by comparing the length of the 1.4-cm long yellow tip of the electric knife to the length of the resected septum. A small uterine septum was defined as having a length of 1.3–1.5 cm.

Results

The preterm birth rate in Group A (n = 420) was 33.9% before and 7.2% after hysteroscopic resection (P < 0.001); the preterm birth rate in Group B (n = 406) was 36.5% before and 8.0% after hysteroscopic resection (P < 0.001). The very preterm birth rate in Group A was 12.5% before and 3.1% after hysteroscopic resection (P < 0.001); the very preterm birth rate in Group B was 15.0% before and 2.9% after hysteroscopic resection (P < 0.001). After surgery, we registered a decreased need for neonatal intensive care, as well as a significant decrease in stillbirth and neonatal death rates in both groups of patients.

Conclusion(s)

Similarly to a large uterine septum, a small uterine septum or arcuate uterus is an important hysteroscopically preventable risk variable for preterm birth.     

Clinical and pathological characteristics,pathological reevaluation and recurrence patterns of cellular leiomyomas: a retrospective study in 76 patients

Objectives

To analyze clinical and pathologic features as well as recurrence patterns of cellular leiomyomas (CL) in women who underwent surgical therapy for symptomatic disease.

Study design

This retrospective study was conducted at the Department of Obstetrics and Gynecology, University Women's Clinic, Tuebingen, Germany. We identified all women who had CL on final diagnosis after surgery between January 1, 2000, and December 31, 2010.

Results

Our study sample comprised 76 women with a diagnosis of CL. A single uterine mass was present in 51.3% of the cases; in uteri with both CL and uterine leiomyomas (UL), the CL constituted the largest uterine mass in 20 of 21 (95.2%) cases. Additionally, in 98% of the uteri, CL were either the largest or the only uterine mass. Five women (6.6%; 5/76) had reported surgical procedures for symptomatic leiomyoma before the index surgery in our analysis. Three women underwent hysteroscopic resection of the leiomyomas and 2 women underwent abdominal myomectomy. Mean time to recurrence was 14.0 months (median 6.0; range, 4.0–52.0). Over the follow-up period, 6 women who underwent uterus-conserving surgery (12.0%; 6/50) with CL had leiomyoma recurrence. Five women underwent abdominal myomectomy and one underwent hysteroscopic resection of the CL. One patient had recurrence of a CL 43 months after abdominal myomectomy and underwent vaginal hysterectomy; the other five women had recurrences of UL. Mean time to recurrence was 28.6 months (median 12.5; range, 4.0–83.0).

Conclusions

Recurrence rates of CL in our study group resemble recurrence rates of UL.     

A comparison of intrauterine balloon,intrauterine contraceptive device and hyaluronic acid gel in the prevention of adhesion reformation following hysteroscopic surgery for Asherman syndrome: a cohort study

Objective

To compare the efficacy of intrauterine balloon, intrauterine contraceptive device and hyaluronic acid gel in the prevention of the adhesion reformation after hysteroscopic adhesiolysis for Asherman's syndrome.

Study design

Retrospective cohort study of 107 women with Asherman's syndrome who were treated with hysteroscopic division of intrauterine adhesions. After hysteroscopic adhesiolysis, 20 patients had intrauterine balloon inserted, 28 patients had intrauterine contraceptive device (IUD) fitted, 18 patients had hyaluronic acid gel instilled into the uterine cavity, and 41 control subjects did not have any of the three additional treatment measures. A second-look hysteroscopy was performed in all cases, and the effect of hysteroscopic adhesiolysis was scored by the American Fertility Society classification system.

Results

Both the intrauterine balloon group and the IUD group achieved significantly (P < 0.001) greater reduction in the adhesion score than that of the hyaluronic acid gel group and control group. The efficacy of the balloon was greater than that of the IUD (P < 0.001). There was no significant difference in results between the hyaluronic acid gel group and the control groups.

Conclusion

The insertion of an intrauterine balloon or intrauterine device is more effective than the use of hyaluronic acid gel in the prevention of intra-uterine adhesion reformation.