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

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.

Uterine factors in recurrent pregnancy losses

“…Some cases of uterine rupture during subsequent pregnancies have also been reported (35,36). Abdominal ultrasound guidance during surgery, the use of barrier gels, and postoperative hysteroscopies are options aimed at reducing postoperative complications (37).…”

“…The risk of complications increases for myomas having a diameter >3 cm (52). Intrauterine hyaluronic-based barrier gels and postoperative diagnostic hysteroscopy at 4-6 weeks decrease the risk of adhesions after myomectomies (37). Other types and multiple myomas need an abdominal approach to the myomectomy (54).…”

“…Characteristically, these alterations are encountered after uterine curettages, infections, and intrauterine surgery or postobstetrical complications such as, notably, retained fragments of placenta. Intrauterine adhesions are also frequent complications of hysteroscopic surgery for polypectomy, myomectomy, and lysis of adhesions (10%-30%) (37). The prevalence of IUAs in RPL varies from 1.3% to 9.6%, depending on the study (6,7,9).…”

“…These precautions include, notably, practicing second-look office hysteroscopy for identifying and easily removing newly formed IUAs approximately 4 weeks after surgery. This practice should be recommended for all women undergoing hysteroscopic surgery with a risk of IUA recurrence (resection for myomas, polyps, or IUAs) (37). Contrary to the clinical practice at our intuition, the ESHRE and ASRM guidelines conclude that there is insufficient evidence of a benefit for surgical removal of IUAs in women with RPL (3,12).…”

A Novel Rat Model to Test Intra-Abdominal Anti-adhesive Therapy

“…Around 7 million open abdominal surgeries occur each year in the US and Europe with adhesions estimated in up to 90% of cases, costing the USA health care system $USD 2.3 billion annually (1). Postsurgical adhesions are the largest single cause of intestinal obstruction with a mortality rate of 10% and can also contribute to female infertility (2)(3)(4)(5). Numerous strategies have been recommended to prevent peritoneal adhesions; however, none are widely adopted due to poor efficacy or risk of adverse events (6).…”