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.

  • Shvetha Zarek

    Thank you to the authors for presenting an excellent paper that teaches about the historical perspective of Asherman Syndrome and provides very useful clinical data in counseling patients about optimal methods of treatment. The techniques that are employed demonstrate impressive results. A minor question. Will the randomized trial discussed evaluate only adjuvant estrogen treatment or adjuvant estrogen and progesterone treatment in the 40 day schedule as described in the paper?

  • Daniel J. Kaser, MD

    Dear Dr. Hanstede and colleagues,
    Congratulations on this large series of patients with surgically corrected Asherman’s syndrome. The data on adhesion grade according to precipitating factor (e.g. first0trimester D&C vs. postpartum hemorrhage), and also the risk of recurrence according to adhesion grade, are both helpful for patient counseling. Given the very high success rates with your approach, is it possible to provide further data that stratifies patients who had an IUD placed at the initial adhesiolysis vs. those that did not? In the absence of an RCT comparing standard postoperative hormone supplementation to hormones + IUD, this subanalysis may prove insightful. Thanks for your comments.

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