Results of centralized Asherman surgery 2003 2013

Capsule:
Hysteroscopic adhesiolysis for Asherman syndrome resulted in restoration of a healthy uterine cavity in 95% of women treated, in 1–3 attempts, with a 28.7% recurrence rate of intrauterine adhesions.

Authors:
Miriam M.F. Hanstede, M.D., Eva van der Meij, M.D., Laurien Goedemans, M.D., Mark H. Emanuel, M.D., Ph.D.

Volume 104, Issue 6, Pages 1561-1568

Abstract:

Objective:
To study the success rate of hysteroscopic adhesiolysis and the spontaneous recurrence rate of intrauterine adhesions (IUAs) in patients with Asherman syndrome.

Design:
Cohort study.

Setting:
University-affiliated hospitals.

Patient(s):
A total of 638 women with Asherman syndrome were included, all diagnosed using hysteroscopy, and operated on between 2003 and 2013.

Intervention(s):
None.

Main Outcome Measure(s):
Hysteroscopic adhesiolysis was classified as successful if a normalization of menstrual blood flow occurred, along with a restored, healthy, cavity anatomy, free of adhesions, with hysteroscopic visualization of ≥1 tubal ostium. Recurrences of adhesions were diagnosed using hysteroscopy after an initial successful procedure.

Result(s):
A first-trimester procedure preceded Asherman syndrome in 371 women (58.2%) and caused adhesions of grades 1–2A. In 243 (38.1%) women, a postpartum procedure caused IUAs of grades 3–5). The procedure was successful in 606 women (95%), and restoration of menstrual blood flow occurred in 97.8%; IUAs spontaneously recurred in 174 (27.3%) of these cases. High grades of adhesions were predictive of a higher chance of spontaneous recurrence of adhesions.

Conclusion(s):
In 95% of women with Asherman syndrome, a healthy uterine cavity was restored with hysteroscopic adhesiolysis, in 1–3 attempts, with a 28.7% recurrence rate of spontaneous IUAs.

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