DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20181897

Practice of diagnostic hysteroscopy after myomectomy in the prevention of intrauterine adhesions: experience of Ouakam military hospital (Dakar, Senegal)

Marie Edouard Faye Dieme, Mouhamadou Mansour Niang, Omar Gassama, Abdoul Aziz Diouf, Marietou Thiam Coulibaly, Alassane Diouf, Jean Charles Moreau

Abstract


Background: Surgical treatment of myomas may be the cause of some complications, including intrauterine adhesions. The objective of the study was to evaluate the incidence of intrauterine adhesions in patients who underwent myomectomy by laparotomy or hysteroscopic resection.

Methods: We carried out a prospective single center study from August 1st 2016 to May 31st 2017 in the gynaecological and obstetrical department of Ouakam the Military Hospital (Senegal). We included patients who underwent myomectomy by laparotomy with opening of the uterine cavity or myomectomy by hysteroscopy. A diagnostic hysteroscopy was performed to search post-operative intrauterine adhesions. For each patient, we studied the socio-demographic aspects, the surgical approach, the delay of diagnostic hysteroscopy, the appearance of uterine cavity and the tolerance of hysteroscopy.

Results: 54 patients underwent the diagnostic hysteroscopy. The mean age was 36 years old. The main indication of myomectomy was menorrhagia. 37 patients underwent myomectomy by laparotomy and 17 by hysteroscopy. Each case was followed by a post-operative diagnostic hysteroscopy with a mean delay time of 58 days. We found post-operative intrauterine adhesions in 7 patients (5 in the laparotomy group and 2 in hysteroscopy group).

Conclusions: Early diagnostic hysteroscopy after myomectomy should be done in our context to reduce post-operative intrauterine adhesions and preserve the patient’s fertility.


Keywords


Diagnostic hysteroscopic, Intrauterine adhesions, Synechiae, Senegal myomectomy, Uterine myomas

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References


Wise LA, Palmer JR, Cozier YC, Hunt MO, Stewart E, Rosenberg L. Perceived Racial Discrimination and Risk of Uterine Leiomyomata. Epidemiol 2007;18(6):747-57.

Marret H, Fritel X, Ouldamer L, Bendifallah S, Brun JL, De Jesus L et al. Therapeutic management of uterine fibroid tumors: updated french guidelines. Eur J Obstet Gynecol Reprod Biol. 2012;165(2):156-64.

Valle RF, Sciarra JJ. Intra-uterine adhesions: hysteroscopic diagnosis, classification, treatment and reproductive out-come. Am J Obstet Gynecol. 1988;158(6):1459-70.

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(5):1254-9.

Warembourg S, Huberlant S, Garric X, Leprince S, De Tayrac R, Letouzey V. Prevention and treatment of endo-uterine synechia: Literature review. J Gynecol Obstet Biol Reprod. 2015;44(4):366-379.

Asherman JG. Amenorrhoea traumatica (atretica). J Obstet Gynaecol Br Emp. 1948;55(1):23-30.

Sharma JB, Roy KK, Pushparaj M, Gupta N, Jain SK, Malhotra N. Genital tuberculosis: an important cause of Asherman’s syndrome in India. Arch Gynecol Obstet. 2008;277(1):37-41.

Schenker JG, Margalioth EJ. Intra-uterine adhesions: an updated appraisal. Fertil Steril 1982;37(5):593-605.

Munoz JL, Jiménez JS, Hernandez C, Vaquero G, Pérez Sagaseta C, Noguero R. et al., Hysteroscopic myomectomy: our experience and review. JSLS 2003;7(1):39-48.

Taskin O, Sadik S, et al. Role of endometrial suppression on the frequency of intrauterine adhesions after resectoscopic surgery. J Am Assoc Gynecol Laparosc. 2000;7(3):351–4.

Touboul C, Fernandez H, Deffieux X, Berry R, Frydman R, Gervaise A. Uterine synechiae after bipolar hysteroscopic resection of submocosal myomas in patients with infertility. Fertil Steril 2009; 92(5):1690-3.

Fernandez H, Kadoch O, Capella-Allouc S, Gervaise A, Taylor S, Frydman R. Hysteroscopic resection of sub-mucosal myomas: long-term results. Ann Chir 2001;126(7):58-64.

Mazzon I, Favilli A, Cocco P, Grasso M, Horvath S, Bini V, et al. Does cold loop hysteroscopic myomectomy reduce intrauterine adhesions? A retrospective study. Fertility and Steril. 2014; 101(1): 294-8.

Shokeir TA, Fawzy M, Tatongy M. The nature of intrauterine adhesions following reproductive hysteroscopic surgery as determined by early and late follow-up hysteroscopy: clinical implications. Arch Gynecol Obstet. 2008;277(5):423-7.

Deffieux X, Gauthier T, Ménager N, Legendre G, Agostini A, Pierre F. Prevention of complications of hysteroscopy: recommendations for clinical practice. J Gynecol Obstet Biol Reprod 2013;42(8):1032-49.

Revaux A, Ducarme G, Luton D. Prevention of synechia after surgical hysteroscopy. Gynecol Obstet Fertil 2008;36:311-317.

Frey C, Chanelles O, Poncelet C. Post-operative uterine synechia: what means of prevention? Gynecol Obstet Fertil. 2010;38:550-2.