Hysteroscopy pp 719-724 | Cite as

Prevention of Adhesion Reformation After Hysteroscopic Surgery

  • Narendra Malhotra
  • Shally Gupta
  • Rahul Manchanda
  • Jaideep Malhotra
  • Keshav Malhotra
  • Manpreet Sharma
  • Shemi Bansal
Chapter

Abstract

Uterine adhesions are significant fertility complications. Intrauterine adhesions are fairly a common finding in cases of oligomenorrhea and amenorrhea, especially in developing countries following various infections and tuberculosis. All efforts for adhesion prevention should be done to have better outcome.

The major strategies for intrauterine adhesion formation prevention are divided into four categories, viz., surgical management, early second look hysteroscopy, barrier agents, and pharmacological therapies. Hysteroscopic surgical strategies include reduction in use of electrosurgery and using cold loop. Early second look hysteroscopy as early as 1 or 2 week after primary hysteroscopy has shown promising result in adhesion prevention. Use of barrier agents like hyaluronic gel and IUCD like lippes loop are other effective strategies for adhesion prevention. Pharmacological interventions like estrogen and progesterone therapy, post-surgery antibiotics, etc. are also useful. Newer novel techniques like platelet-rich plasma and stem cell therapy are other therapies used.

Keywords

Intrauterine adhesion Prevention strategy Operative hysteroscopy 

References

  1. 1.
    Asherman JG. Amenorrhea traumatic (atretica). Obstet Gynaecol Br Emp. 1948;55:23.CrossRefGoogle Scholar
  2. 2.
    Taskin O, Sadik S, Onoglu A, et al. Role of endometrial suppression on the frequency of intrauterine adhesions after resectoscopic surgery. J Am Assoc Gynecol Laparosc. 2000;7:351–4.CrossRefPubMedGoogle Scholar
  3. 3.
    Touboul C, Fernandez H, Deffieux X, et al. Uterine synechiae after bipolar hysteroscopic resection of submucosal myomas in patients with infertility. Fertil Steril. 2009;92:1690–3.CrossRefPubMedGoogle Scholar
  4. 4.
    Menzies D. Postoperative adhesions: their treatment and relevance in clinical practice. Ann R Coll Surg Engl. 1993;75:147–53.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Schenker JG. Etiology of and therapeutic approach to synechia uteri. Eur J Obstet Gynecol Reprod Biol. 1996;65:109–13.CrossRefPubMedGoogle Scholar
  6. 6.
    Valle RF, Sciarra JJ. Intrauterine adhesions: hysteroscopic diagnosis, classification, treatment, and reproductive outcome. Am J Obstet Gynecol. 1988;158:1459–70.CrossRefPubMedGoogle Scholar
  7. 7.
    March CM. Intrauterine adhesions. Obstet Gynecol Clin N Am. 1995;22:491–505.Google Scholar
  8. 8.
    March C, Israel R, March A. Hysteroscopic management of intrauterine adhesions. Am J Obstet Gynecol. 1978;653–657(Class II-3):130.Google Scholar
  9. 9.
    Hamou J, Salat-Baroux J, Siegler A. Diagnosis and treatment of intrauterine adhesions by microhysteroscopy. Fertil Steril. 1983;321–326(Class II-3):39.Google Scholar
  10. 10.
    Valle RF, Sciarra JJ. Intrauterine adhesions: hysteroscopic diagnosis, classification, treatment, and reproductive outcome. Am J Obstet Gynecol. 1988;1459–1470(Class III):158.Google Scholar
  11. 11.
    Wamsteker K. European Society for Hysteroscopy (ESH) classification of IUA (Class III). Class III: ESH; 1989.Google Scholar
  12. 12.
    American Fertility Society. American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, mullerian anomalies and intrauterine adhesions. Fertil Steril. 1988;49:944–55.CrossRefGoogle Scholar
  13. 13.
    Donnez J, Nisolle M. Hysteroscopic adhesiolisys of intrauterine adhesions (Asherman syndrome). In: Donnez J, editor. Class III. London: Parthenon Publishing Group; 1994.Google Scholar
  14. 14.
    Nasr A, Al-Inany H, Thabet S, Aboulghar M. A clinic-hysteroscopic scoring system of intrauterine adhesions. Gynecol Obstet Investig. 2000;178–181(Class III):50.Google Scholar
  15. 15.
    Mazzon I, Favilli A, Cocco P, et al. Does cold loop hysteroscopic myomectomy reduce intrauterine adhesions? A retrospective study. Fertil Steril. 2014;101:294–98.e3.CrossRefPubMedGoogle Scholar
  16. 16.
    Golan A, Dishi M, Shalev A, Keidar R, Ginath S, Sagiv R. Operative hysteroscopy to remove retained products of conception: novel treatment of an old problem. J Minim Invasive Gynecol. 2011;18:100–3.CrossRefPubMedGoogle Scholar
  17. 17.
    Rein DT, Schmidt T, Hess AP, Volkmer A, Schondorf T, Breidenbach M. Hysteroscopic management of residual trophoblastic tissue is superior to ultrasoundguided curettage. J Minim Invasive Gynecol. 2011;18:774–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Barel O, Krakov A, Pansky M, Vaknin Z, Halperin R, Smorgick N. Intrauterine adhesions after hysteroscopic treatment for retained products of conception: what are the risk factors? Fertil Steril. 2015;103:775–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Robinson JK, Swedarsky Colimon LM, Isaacson KB. Postoperative adhesiolisys therapy for intrauterine adhesions (Asherman’s syndrome). Fertil Steril. 2008;90:409–14.CrossRefPubMedGoogle Scholar
  20. 20.
    Pabuccu R, Onalan G, Kaya C, et al. Efficiency and pregnancy outcome of serial intrauterine device-guided hysteroscopic adhesiolisys of intrauterine synechiae. Fertil Steril. 2008;90:1973–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Yang JH, Chen MJ, Wu MY, Chao KH, Ho HN, Yang YS. Office hysteroscopic early lysis of intrauterine adhesion after transcervical resection of multiple apposing submucous myomas. Fertil Steril. 2008;89:1254–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Orhue AA, Aziken ME, Igbefoh JO. A comparison of two adjunctive treatments for intrauterine adhesions following lysis. Int J Gynaecol Obstet. 2003;82:49–56.CrossRefPubMedGoogle Scholar
  23. 23.
    Roy KK, Baruah J, Sharma JB, Kumar S, Kachawa G, Singh N. Reproductive outcome following hysteroscopic adhesiolisys in patients with infertility due to Asherman’s syndrome. Arch Gynecol Obstet. 2010;281:355–61.CrossRefPubMedGoogle Scholar
  24. 24.
    Tonguc EA, Var T, Yilmaz N, Batioglu S. Intrauterine device or estrogen treatment after hysteroscopic uterine septum resection. Int J Gynaecol Obstet. 2010;109:226–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Lin X, Wei M, Li TC, et al. A comparison of intrauterine balloon, intrauterine contraceptive device and hyaluronic acid gel in the prevention of adhesion reformation following hysteroscopic surgery for Asherman syndrome: a cohort study. Eur J Obstet Gynecol Reprod Biol. 2013;170:512–6.CrossRefPubMedGoogle Scholar
  26. 26.
    Guida M, Acunzo G, Di Spiezio Sardo A, et al. Effectiveness of auto-crosslinked hyaluronic acid gel in the prevention of intrauterine adhesions after hysteroscopic surgery: a prospective, randomized, controlled study. Hum Reprod. 2004;19:1461–4.CrossRefPubMedGoogle Scholar
  27. 27.
    Acunzo G, Guida M, Pellicano M, et al. Effectiveness of auto-cross-linked hyaluronic acid gel in the prevention of intrauterine adhesions after hysteroscopic adhesiolisys: a prospective, randomized, controlled study. Hum Reprod. 2003;18:1918–21.CrossRefPubMedGoogle Scholar
  28. 28.
    De Iaco PA, Muzzupapa G, Bovicelli A, et al. Hyaluronan derivative gel in intrauterine adhesion (IUA) prevention after operative hysteroscopy. Ellipse. 2003;19:15–8.Google Scholar
  29. 29.
    Di Spiezio Sardo A, Spinelli M, Bramante S, et al. Efficacy of a polyethylene oxide-sodium carboxymethylcellulose gel in prevention of intrauterine adhesions after hysteroscopic surgery. J Minim Invas Gynecol. 2011;18:462–9.CrossRefGoogle Scholar
  30. 30.
    ACOG Committee on Practice Bulletins. ACOG practice bulletin no. 74. Antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol. 2006;108:225–34.CrossRefGoogle Scholar
  31. 31.
    AAGL. AAGL advancing minimally invasive gynecology worldwide. AAGL practice report: practice guidelines for management of intrauterine synechiae. J Minim Invasive Gynecol. 2010;17:1–7.CrossRefGoogle Scholar
  32. 32.
    Singh N, Mohanty S, Seth T, Shankar M, Bhaskaran S, Dharmendra S. Autologous stem cell transplantation in refractory Asherman’s syndrome: a novel cell based therapy. J Hum Reprod Sci. 2014;7(2):93–8. doi: 10.4103/0974-1208.138864.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Chang Y, Li J, Chen Y, et al. Autologous platelet-rich plasma promotes endometrial growth and improves pregnancy outcome during in vitro fertilization. Int J Clin Exp Med. 2015;8(1):1286–90.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Narendra Malhotra
    • 1
  • Shally Gupta
    • 2
  • Rahul Manchanda
    • 5
    • 6
  • Jaideep Malhotra
    • 3
  • Keshav Malhotra
    • 2
  • Manpreet Sharma
    • 4
  • Shemi Bansal
    • 4
  1. 1.Professor, Global Rainbow HealthcareRainbow HospitalAgraIndia
  2. 2.Consultant, Rainbow IVFRainbow HospitalAgraIndia
  3. 3.Proferror, Rainbow IVFRainbow HospitalAgraIndia
  4. 4.Consultant, Global Rainbow HealthcareRainbow HospitalAgraIndia
  5. 5.Consultant, Global Rainbow HealthcareRainbow HospitalAgraIndia
  6. 6.Manchanda’s Endoscopy CenterNew DelhiIndia

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