J Clin Obstet Gynecol Infertil | Volume 8, Issue 1 | Case Series | Open Access
da Cunha Vieira M1,2, Kondo W3, Menakaya U4 and diZerega G5,6*
1Department of Gynecology, Hospital das Clinicas HCFMUSP & University of Sao Paulo, Brazil 2Division of Gynecology, BP - A Beneficencia Portuguesa de Sao Paulo, Brazil 3Sugisawa Hospital, Avenida Iguaçu, Brazil 4Obstetrician, Gynecologist, Sonologist and Laparoscopic Surgeon, JUNIC Specialist Imaging and Women’s Center, Australia 5Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, USA 6FzioMed, San Luis Obispo, California, USA
*Correspondance to: Gere diZerega
Fulltext PDFDifficult hysteroscopic procedures, such as septoplasty and lysis of severe adhesions, can often lead to the formation of adhesions and result in poor clinical outcomes, including menstrual disorders, infertility, and gestational loss. The hysteroscopic surgical procedures, performed in the three case reports presented in this article, including septoplasty and lysis/removal of severe adhesions, resulted in no adhesion formation in the uterine cavity and achieved good clinical outcomes. In a retrospective study, 31% of patients developed intrauterine adhesions following septoplasty. Those with a history of prior endometrial curettage or miscarriage followed by curettage had a 44% to 46% rate of intrauterine adhesions. To prevent the reformation of adhesions following adhesiolysis or septoplasty, many gynecologists are inserting space occupying materials, such as balloons, IUDs, and gels into the uterine cavity post hysteroscopic procedures. These treatments have been beneficial for patients following hysteroscopic resection of adhesions, septum, myomas or retained products of conception. In this article, we report on the successful outcomes of three patients, treated by three different gynecologists, at different centers, each undergoing challenging hysteroscopic surgery to remove extensive disease, including a uterine septum and severe adhesions. Following these procedures, a synthetic dual polymer gel (CMC+PEO) was inserted into their uterine cavities. The results extended previous observations, showing no adhesions, normalization of menstruation, and successful pregnancies that went to term. In conclusion, insertion of a synthetic gel into the intrauterine cavity, as demonstrated in these three case reports, resulted in good clinical outcomes, following difficult hysteroscopic surgery. Although intrauterine gels are currently available for use, randomized, multicenter, clinical trials with clinically focused primary outcomes are needed to further characterize the benefits of this simple approach to adhesion prevention.
da Cunha Vieira M, Kondo W, Menakaya U, diZerega G. Uterine Septoplasty and Adhesiolysis: Difficult Hysteroscopic Surgery and Intrauterine Carboxymethyl Cellulose + Polyethylene Oxide Dual Polymer Gel Resulted in Good Clinical Outcomes: Three Case Reports. J Clin Obstet Gynecol Infertil. 2024; 8(1): 1067..