title: The influence of the location and extent of intrauterine adhesions on recurrence after hysteroscopic adhesiolysis.
abstract: OBJECTIVE
  To investigate the recurrence potential of intrauterine adhesions after hysteroscopic adhesiolysis.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Tertiary university hospital.
  
  
  METHODS
  This study included 115 women who had intrauterine adhesions completely separated during hysteroscopic surgery. The treated adhesions were classified into four groups according to their location and extent: Group 1, central type (i.e. intervening space between the adhesions and both lateral uterine sidewalls) at the middle area of uterine cavity; Group 2, central type at uterine cornua; Group 3, cervico-isthmic; and Group 4, extensive if the adhesions were dense with occlusion of part of the uterine cavity other than cervico-isthmic region.
  
  
  METHODS
  Postoperative outpatient hysteroscopic adhesiolysis was scheduled 10-14 days after the initial hysteroscopic surgery and procedures were repeated every 10-14 days until no reformed adhesions were detected. Multivariate logistic regression models were built to examine initial adhesion characteristics and other factors associated with adhesion reformation and need for subsequent outpatient adhesiolysis. Categorical data were compared using Fisher's exact test.
  
  
  METHODS
  Number of postoperative outpatient hysteroscopic adhesiolysis procedures.
  
  
  RESULTS
  The location and extent of adhesions according to the allocated group was the only parameter independently related to the number of postoperative outpatient adhesiolysis procedures (P = 0.0004). Women with Group 1 adhesions underwent a lower number of postoperative interventions compared with those with Group 2, 3 and 4 adhesions (P = 0.0355, P = 0.0004 and P = 0.0087, respectively).
  
  
  CONCLUSIONS
  There is an increased likelihood of intrauterine adhesion recurrence when successfully divided adhesions were originally located at the uterine cornua, the cervico-isthmic region or involved a large portion of the uterine cavity.
authors.affiliation: Department of Obstetrics and Gynaecology, College of Medicine and the Hospital, National Taiwan University, Taipei, Taiwan.
authors.forename: J-H
authors.initials: JH
authors.lastname: Yang
authors.affiliation: Department of Obstetrics and Gynaecology, College of Medicine and the Hospital, National Taiwan University, Taipei, Taiwan.
authors.forename: C-D
authors.initials: CD
authors.lastname: Chen
authors.affiliation: Department of Obstetrics and Gynaecology, College of Medicine and the Hospital, National Taiwan University, Taipei, Taiwan.
authors.forename: S-U
authors.initials: SU
authors.lastname: Chen
authors.affiliation: Department of Obstetrics and Gynaecology, College of Medicine and the Hospital, National Taiwan University, Taipei, Taiwan.
authors.forename: Y-S
authors.initials: YS
authors.lastname: Yang
authors.affiliation: Department of Obstetrics and Gynaecology, College of Medicine and the Hospital, National Taiwan University, Taipei, Taiwan.
authors.forename: M-J
authors.initials: MJ
authors.lastname: Chen
mesh_terms: D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects*; D007434:Intrauterine Devices; D011183:Postoperative Complications / Q000473:pathology* / Q000517:prevention & control; D012008:Recurrence; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000209:etiology / Q000473:pathology* / Q000517:prevention & control / Q000601:surgery*; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000150:complications / Q000473:pathology* / Q000601:surgery
keywords: Adhesion reformation; hysteroscopy; intrauterine adhesion