title: Metroplasty to treat chronic pelvic pain resulting from outflow tract müllerian anomalies.
abstract: Chronic pelvic pain can result from noncommunicating uterine cavities in patients with müllerian anomalies. Traditional management has been to resect the noncommunicating uterine horn. Two cases are described. One had a unicornuate uterus with noncommunicating left uterine horn (American Fertility Society [AFS] classification IIb) and the other had a normal external uterine contour with noncommunicating left uterine cavity that did not fit any category of the AFS classification of müllerian anomalies. Attempts at connecting the noncommunicating cavities hysteroscopically failed in both cases. Successful unification of the cavities was subsequently achieved in the first case using the classic Strassman metroplasty with the assistance of the robot. The unification of uterine cavities was achieved using a modified Strassman metroplasty in the second patient, as there was no uterine horn for landmark. Robot assistance was utilized in this case as well. Both patients are symptom free after surgery. We conclude that laparoscopic Strassman metroplasty, with or without robot assistance, is a viable alternative to resection of uterine horns in patients with hematometra, chronic pelvic pain, and noncommunicating uterine cavities.
authors.affiliation: Department of Obstetrics and Gynecology at School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY.
authors.forename: Bala
authors.initials: B
authors.lastname: Bhagavath
authors.affiliation: Department of Boonshoft School of Medicine, Wright State University, Dayton, OH.
authors.forename: Eric
authors.initials: E
authors.lastname: Behrman
authors.affiliation: Department of Boonshoft School of Medicine, Wright State University, Dayton, OH.
authors.forename: Bijan W
authors.initials: BW
authors.lastname: Salari
authors.affiliation: Department of Obstetrics and Gynecology at School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY.
authors.forename: Wendy
authors.initials: W
authors.lastname: Vitek
authors.affiliation: Department of Boonshoft School of Medicine, Wright State University, Dayton, OH.
authors.forename: Sheela
authors.initials: S
authors.lastname: Barhan
authors.affiliation: Department of Boonshoft School of Medicine, Wright State University, Dayton, OH.
authors.forename: Jerome L
authors.initials: JL
authors.lastname: Yaklic
authors.affiliation: Department of Boonshoft School of Medicine, Wright State University, Dayton, OH.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Lindheim
mesh_terms: D000293:Adolescent; D059350:Chronic Pain / Q000209:etiology / Q000601:surgery*; D005260:Female; D006409:Hematometra / Q000601:surgery; D006801:Humans; D017699:Pelvic Pain / Q000209:etiology / Q000601:surgery*; D014599:Uterus / Q000002:abnormalities* / Q000601:surgery*; D055815:Young Adult