title: Results of centralized Asherman surgery, 2003-2013.
abstract: OBJECTIVE
  To study the success rate of hysteroscopic adhesiolysis and the spontaneous recurrence rate of intrauterine adhesions (IUAs) in patients with Asherman syndrome.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  University-affiliated hospitals.
  
  
  METHODS
  A total of 638 women with Asherman syndrome were included, all diagnosed using hysteroscopy, and operated on between 2003 and 2013.
  
  
  METHODS
  Hysteroscopic adhesiolysis.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynaecology, Spaarne Ziekenhuis Hoofddorp, Hoofddorp, the Netherlands. Electronic address: mhanstede@spaarneziekenhuis.nl.
authors.forename: Miriam M F
authors.initials: MM
authors.lastname: Hanstede
authors.affiliation: Department of Obstetrics and Gynaecology, Spaarne Ziekenhuis Hoofddorp, Hoofddorp, the Netherlands.
authors.forename: Eva
authors.initials: E
authors.lastname: van der Meij
authors.affiliation: Department of Obstetrics and Gynaecology, Spaarne Ziekenhuis Hoofddorp, Hoofddorp, the Netherlands.
authors.forename: Laurien
authors.initials: L
authors.lastname: Goedemans
authors.affiliation: Department of Obstetrics and Gynaecology, Spaarne Ziekenhuis Hoofddorp, Hoofddorp, the Netherlands.
authors.forename: Mark Hans
authors.initials: MH
authors.lastname: Emanuel
mesh_terms: D000328:Adult; D002497:Centralized Hospital Services / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D006175:Gynatresia / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D006785:Hospitals, University / Q000458:organization & administration*; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects; D008598:Menstruation; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012008:Recurrence; D012017:Referral and Consultation; D012086:Reoperation; D013997:Time Factors; D000267:Tissue Adhesions; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D014599:Uterus / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult
keywords: Asherman syndrome; Intrauterine adhesions; adhesions; amenorrhea; hysteroscopic adhesiolysis; hysteroscopy