Postsurgical barrier strategies to avoid the recurrence of intrauterine adhesion formation after hysteroscopic adhesiolysis: a network meta-analysis of randomized controlled trials

Vitale, Salvatore Giovanni; Riemma, Gaetano; Carugno, Josè; Pérez-Medina, Tirso; Pacheco, Luis Alonso; Haimovich, Sergio; Parry, John; Sardo, Attilio Di Spiezio; Franciscis, Pasquale De

doi:10.1016/j.ajog.2021.09.015

Cited by 70 publications

(39 citation statements)

References 28 publications

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“…There are many types of non-hormonal IUDs currently available in Europe, including the Copper T IUD, and the Multiload Copper IUD with a horse-shoe shape [7]. Also, the placement of a non-hormonal IUD after hysteroscopic lysis of adhesions or any other intrauterine adhesion generating procedure such as extensive myomectomy, is an effective strategy to avoid intrauterine adhesion formation and restore a normal anatomy of the uterine cavity [8,9].…”

Section: Introductionmentioning

confidence: 99%

In-office hysteroscopic removal of retained or fragmented intrauterine device without anesthesia: a cross-sectional analysis of an international survey

et al. 2022

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To investigate about the opinions of gynecologists regarding the in-office hysteroscopic removal of retained or fragmented intrauterine device (IUD) without anesthesia. An online survey was made available to gynecologists who routinely performed in-office hysteroscopy. Five areas of interest were analyzed: average number of hysteroscopic procedures performed without anesthesia, availability on their local market of the different types of hormonal and non-hormonal IUDs, reasons for the hysteroscopic removal of the IUD, types of IUDs that were more commonly found retained or fragmented and, overall difficulty of the hysteroscopic removal. A total of 419 surgeons voluntarily responded the survey, of which 19 were excluded for not performing in-office hysteroscopy. The most commonly available IUD was the Levonorgestrel-based Mirena (Bayer Healthcare, Germany) or similar, (399/400, 99.7%), followed by Copper T (Paragard, CooperSurgical INC, United States) (397/400, 99.2%), Multiload (234/400, 58.5%) and Jaydess (Bayer Healthcare, Germany) (227/400, 56.7%). The intracavitary retention of the IUD with (44.5%, 178/400) and without (42.2%, 169/400) visible strings accounted as the most common reason for undergoing hysteroscopic IUD removal. Copper T IUD was the most common intracavitary retained (297/400, 74.2%) as well as fragmented device (236/400, 59.9%). The in-office hysteroscopic removal of the IUD was considered an easy procedure by almost all the operators (386/400, 96.5%). In-office hysteroscopy without anesthesia is seen as a feasible and easy approach to remove retained or fragmented IUDs inside the uterine cavity or cervical canal. While the Levonorgestrel-based IUD is the most commercialized, Copper T IUDs are the most commonly found retained or fragmented.

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Section: Introductionmentioning

confidence: 99%

In-office hysteroscopic removal of retained or fragmented intrauterine device without anesthesia: a cross-sectional analysis of an international survey

et al. 2022

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“…Although vacuum aspiration is currently the standard surgical management in most centres, the use of hysteroscopy has the advantage of direct visualisation of the uterine cavity in order to eliminate any risk of retained products without fear of further curettage [ 17 , 18 ]. There is another advantage of hysteroscopic management over blind curettage as regards the fertility outcome, which is not only prevention of postoperative intrauterine adhesions but also hysteroscopic adhesiolysis [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Hysteroscopic management versus ultrasound-guided evacuation for women with first-trimester pregnancy loss, a randomised controlled trial

et al. 2022

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Objective We aimed to evaluate the hysteroscopic management of first-trimester pregnancy loss compared to surgical evacuation either blind or under ultrasonographic guidance‎. Methods This clinical trial included ‎315 women with first-trimester pregnancy loss, divided equally into three groups. Group 1 underwent traditional blind surgical evacuation, group 2 underwent ultrasound-guided evacuation, and group 3 underwent hysteroscopic management. All women were assessed for retained products, surgical complications, the need for further management, and pregnancy occurrence after evacuation within 2 years of follow up. Results The rate of presence of conception remnants and the need for further ‎treatment was significantly higher in group 1 compared to groups 2 and 3 (4.8% vs. 0% vs. 0%, P = 0.012). The conception rate within 2 years was significantly lower in group 1 compared to groups 2 and 3 (57.4% vs. 73.2% vs. 82.7%, P = 0.002), and the duration needed to conceive was significantly prolonged in group 1 compared to groups 2 and 3 (9.8 vs. 8.3 vs. 6.9 months, P < 0.001). Interestingly, women who underwent hysteroscopic management needed a significantly shorter time to conceive than those who underwent ultrasound-guided evacuation‎ (6.9 vs. 8.3 months, P = 0.006). Conclusions Hysteroscopic management of first-trimester pregnancy loss was superior to ultrasound-guided surgical evacuation regarding the time interval to conceive. Both techniques were superior to the blind evacuation technique regarding removal of the whole conception remnants, need for further treatment and fertility outcomes. Clinical trial registration: It was first registered at ClinicalTrials.gov on 16/03/2017 with registration number NCT03081104.

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“…Weinberg et al (2021) proposed the use of TRD to primarily treat EPL as a safe and feasible procedure in selected cases (Weinberg et al, 2021). The use of crosslinked hyaluronic acid gel should be considered to prevent IUAs formation after complete evacuation of the uterine cavity (Vitale et al, 2022). Hysteroscopic treatment of EPL has several limitations compared to D&C, in particularly, the risk of potential fluid overload syndrome and the higher equipment costs.…”

Section: Discussionmentioning

confidence: 99%

Hysteroembryoscopy and hysteroscopic uterine evacuation of early pregnancy loss: A feasible procedure in selected cases

Catena¹,

D'Ippolito²,

Campolo³

et al. 2022

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Hysteroscopic uterine evacuation of early pregnancy loss using tissue removal devices seems to be a safe and feasible procedure in selected cases. The hysteroscopic approach allows the precise localisation of the gestational sac inside the uterine cavity. The endoscopic approach allows one to perform hysteroembryoscopy before uterine evacuation and this technique appears to be more accurate than dilatation & curettage for fetal chromosome karyotyping, with lower maternal cell contamination. This “under vision” procedure may reduce retained products of conception rates and risk of intrauterine adhesions formation.

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Postsurgical barrier strategies to avoid the recurrence of intrauterine adhesion formation after hysteroscopic adhesiolysis: a network meta-analysis of randomized controlled trials

Cited by 70 publications

References 28 publications

In-office hysteroscopic removal of retained or fragmented intrauterine device without anesthesia: a cross-sectional analysis of an international survey

In-office hysteroscopic removal of retained or fragmented intrauterine device without anesthesia: a cross-sectional analysis of an international survey

Hysteroscopic management versus ultrasound-guided evacuation for women with first-trimester pregnancy loss, a randomised controlled trial

Hysteroembryoscopy and hysteroscopic uterine evacuation of early pregnancy loss: A feasible procedure in selected cases

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