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The nature of intrauterine adhesions following reproductive hysteroscopic surgery as determined by early and late follow-up hysteroscopy: clinical implications.
Arch Gynecol Obstet. 2008 May; 277(5):423-7.AG

Abstract

OBJECTIVE

To evaluate the rate and characteristics of postoperative intrauterine adhesions (IUA) that might be formed following hysteroscopic reproductive surgery from both a gross and a histologic perspective as determined by early and late follow-up diagnostic hysteroscopy.

METHODS

Retrospective analysis of 61 women wishing a pregnancy and suffering from a significant intrauterine pathology affecting their reproductive outcome were reviewed. All patients were treated hysteroscopically. Subsequently, they were randomly assigned to perform a follow-up diagnostic hysteroscopy at a variable intervals from their initial surgery. Multiple hysteroscopic-guided biopsies from IUA, when present, were obtained in several cases. Twenty patients were in the early group and had follow-up hysteroscopy performed 2-4 weeks after the initial operation. The late diagnostic group consisted of 41 patients with follow-up hysteroscopy at about 12 months (8-16 months). The two groups were similar to composition. Postoperatively, none of the early diagnostic group underwent hysterosalpingography (HSG) whereas all of the late group performed HSG 4 months following the initial surgery, which showed at least one-third of the cavity free of adhesions. When adhesions were present, no effort was made to lyse them.

RESULTS

At follow-up hysteroscopy, 25% of both groups had no significant adhesions. Grade I adhesions (thin, filmy) occurred in 60% of the early hysteroscopy patients and in only 12% of the late group (P < 0.05). Grade II adhesions were present in 10% of the early group and in up to 41% in the late group (P < 0.05), whereas Grade III adhesions were present in only 5% of the early hysteroscopy group, but in 22% of the late one (P < 0.05). Correlation between hysteroscopic and histologic findings were good in most of cases in both groups. Follow-up to determine the subsequent reproductive outcome revealed similar conception rates in both groups.

CONCLUSION

The IUA that might be formed immediately following hysteroscopic reproductive surgery are histologically different from those appearing a longer time after the original operation. Routine early follow-up hysteroscopy can influence the prognosis resulting from the original surgery.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Fertility Care Unit, Mansoura Faculty of Medicine, Mansoura University Hospital, Mansoura, Egypt. tarekshokeir@hotmail.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17938946

Citation

Shokeir, Tarek A., et al. "The Nature of Intrauterine Adhesions Following Reproductive Hysteroscopic Surgery as Determined By Early and Late Follow-up Hysteroscopy: Clinical Implications." Archives of Gynecology and Obstetrics, vol. 277, no. 5, 2008, pp. 423-7.
Shokeir TA, Fawzy M, Tatongy M. The nature of intrauterine adhesions following reproductive hysteroscopic surgery as determined by early and late follow-up hysteroscopy: clinical implications. Arch Gynecol Obstet. 2008;277(5):423-7.
Shokeir, T. A., Fawzy, M., & Tatongy, M. (2008). The nature of intrauterine adhesions following reproductive hysteroscopic surgery as determined by early and late follow-up hysteroscopy: clinical implications. Archives of Gynecology and Obstetrics, 277(5), 423-7.
Shokeir TA, Fawzy M, Tatongy M. The Nature of Intrauterine Adhesions Following Reproductive Hysteroscopic Surgery as Determined By Early and Late Follow-up Hysteroscopy: Clinical Implications. Arch Gynecol Obstet. 2008;277(5):423-7. PubMed PMID: 17938946.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The nature of intrauterine adhesions following reproductive hysteroscopic surgery as determined by early and late follow-up hysteroscopy: clinical implications. AU - Shokeir,Tarek A, AU - Fawzy,Muhammad, AU - Tatongy,Muhammad, Y1 - 2007/10/16/ PY - 2007/08/11/received PY - 2007/09/17/accepted PY - 2007/10/17/pubmed PY - 2008/10/10/medline PY - 2007/10/17/entrez SP - 423 EP - 7 JF - Archives of gynecology and obstetrics JO - Arch. Gynecol. Obstet. VL - 277 IS - 5 N2 - OBJECTIVE: To evaluate the rate and characteristics of postoperative intrauterine adhesions (IUA) that might be formed following hysteroscopic reproductive surgery from both a gross and a histologic perspective as determined by early and late follow-up diagnostic hysteroscopy. METHODS: Retrospective analysis of 61 women wishing a pregnancy and suffering from a significant intrauterine pathology affecting their reproductive outcome were reviewed. All patients were treated hysteroscopically. Subsequently, they were randomly assigned to perform a follow-up diagnostic hysteroscopy at a variable intervals from their initial surgery. Multiple hysteroscopic-guided biopsies from IUA, when present, were obtained in several cases. Twenty patients were in the early group and had follow-up hysteroscopy performed 2-4 weeks after the initial operation. The late diagnostic group consisted of 41 patients with follow-up hysteroscopy at about 12 months (8-16 months). The two groups were similar to composition. Postoperatively, none of the early diagnostic group underwent hysterosalpingography (HSG) whereas all of the late group performed HSG 4 months following the initial surgery, which showed at least one-third of the cavity free of adhesions. When adhesions were present, no effort was made to lyse them. RESULTS: At follow-up hysteroscopy, 25% of both groups had no significant adhesions. Grade I adhesions (thin, filmy) occurred in 60% of the early hysteroscopy patients and in only 12% of the late group (P < 0.05). Grade II adhesions were present in 10% of the early group and in up to 41% in the late group (P < 0.05), whereas Grade III adhesions were present in only 5% of the early hysteroscopy group, but in 22% of the late one (P < 0.05). Correlation between hysteroscopic and histologic findings were good in most of cases in both groups. Follow-up to determine the subsequent reproductive outcome revealed similar conception rates in both groups. CONCLUSION: The IUA that might be formed immediately following hysteroscopic reproductive surgery are histologically different from those appearing a longer time after the original operation. Routine early follow-up hysteroscopy can influence the prognosis resulting from the original surgery. SN - 0932-0067 UR - https://www.unboundmedicine.com/medline/citation/17938946/The_nature_of_intrauterine_adhesions_following_reproductive_hysteroscopic_surgery_as_determined_by_early_and_late_follow_up_hysteroscopy:_clinical_implications_ L2 - https://dx.doi.org/10.1007/s00404-007-0475-5 DB - PRIME DP - Unbound Medicine ER -