Postoperative adhesiolysis therapy for intrauterine adhesions (Asherman's syndrome).
OBJECTIVE
To evaluate postoperative blunt adhesiolysis after sharp adhesiolysis for the treatment of intrauterine adhesions.


METHODS
Retrospective analysis of 24 patients treated with primary hysteroscopic adhesiolysis followed by hormone therapy and serial flexible office hysteroscopy (Canadian Task Force Classification II-3).


METHODS
University-affiliated community hospital.


METHODS
Twenty-four women with menstrual disorders, pain, or infertility resulting from intrauterine adhesions.


METHODS
Serial, postoperative, hysteroscopic blunt adhesiolysis of recurrent synechiae.


METHODS
Restoration of normal menstrual pattern, relief of dysmenorrhea, improvement in fertility, and improvement in stage of disease.


RESULTS
Eighty-three percent of patients (20/24) presented with amenorrhea or oligomenorrhea, 67% (16/24) had either infertility or recurrent miscarriages, and 54% (13/24) presented with dysmenorrhea. Initially, 50% (12/24) had severe adhesions, 46% (11/24) moderate, and 4% (1/24) minimal disease according to the March criteria. Improvement in menstrual flow occurred in 95% (18/19) of patients, relief of dysmenorrhea occurred in 92% (12/13), and 46% (7/15) of fertility patients were actively pregnant or had delivered viable infants at the conclusion of the study. There was a 92% (22/24) improvement in disease staging over the treatment interval.


CONCLUSIONS
Blunt adhesiolysis with a flexible hysteroscope is effective for maintenance of cavity patency after primary treatment of intrauterine adhesions.
Minimally Invasive Gynecologic Surgery Center, Newton-Wellesley Hospital, Newton, Massachusetts, USA. jrobinson@mfa.gwu.edu
James K
JK
Robinson
Liza M Swedarsky
LM
Colimon
Keith B
KB
Isaacson
D000328:Adult; D004966:Estrogens, Conjugated (USP) / Q000627:therapeutic use; D005260:Female; D006175:Gynatresia / Q000601:surgery / Q000628:therapy*; D006801:Humans; D015907:Hysteroscopy / Q000379:methods; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000601:surgery / Q000628:therapy*
D004966:Estrogens, Conjugated (USP)