Page 31 - WJOLS - Laparoscopic Journal

Fadare Oluwaseun O

reported; however, it is unclear whether hemorrhage is a had initial severe adhesions, but all had minimal adhesions.
less common occurrence or whether it is under-reported Drawbacks of this technique include the risk of ascending
by various studies. vaginal infection from the catheter’s stem passing through
the cervix into the vagina. The overinflated balloon may
Prevention of Recurrence of Adhesion also increase pressure on the uterine walls, which may result

Studies have shown a high rate of reformation of intrauterine in decreased blood flow to uterine walls with potential effects
adhesions (3.1 to 23.5%), especially severe adhesions on endometrial regeneration. In addition, this method can
(20 to 62.5%). Thus, prevention of reformation of adhesions produce significant discomfort for the patient. Randomized
after surgery is essential to successful treatment. Various comparative studies are needed to validate this method’s
methods have been used to achieve this aim. benefits, including the reproductive outcomes.

Intrauterine contraceptive devices: The insertion of an Hyaluronic acid (HA): Recently, hyaluronic acid, a natural
intrauterine device (IUD) has been advocated by many component of the extracellular matrix, the vitreous humor
studies as an effective, widely used method to prevent and synovial fluid of the joint, has been proposed as a barrier
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adhesion reformation. Postoperative use of an IUD keeps agent to prevent adhesion development after abdominal and
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the raw, dissected surfaces separated during the initial healing pelvic surgery. The antiadhesive effects depend on the
phase and may reduce the chances that they will readhere preparation’s molecular weight as well as its concentration. 59
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to one another. In a literature review, March discussed Investigators have studied intrauterine application of
the use of IUDs and concluded that T-shaped IUDs may modified hyaluronic acid (HA), including Seprafilm
have too small surface area to prevent adhesion reformation, (Genzyme Corporation, Cambridge, MA) and auto-
and that IUDs containing copper may induce an excessive crosslinked HA (ACP) gel (Hyalobarriergel; Baxter, Pisa,
inflammatory reaction. Therefore, their use is not advised Italy), to reduce the intrauterine adhesions after adhesiolysis.
in patients who have had intrauterine adhesions. The loop Seprafilm, a bioresorbable membrane formulated from
IUD is considered the best choice for the prevention of chemically modified HA (sodium hyaluronate) and
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reformation of intrauterine adhesions, although it is no carboxymethyl cellulose, has been shown to significantly
longer available in many countries, including Nigeria. reduce intrauterine adhesions. Seprafilm turns into a
Presently, there have been no randomized controlled trials hydrophilic gel approximately 24 hours after placement and
to confirm the usefulness of IUDs in preventing adhesion provides a protective coating around traumatized tissues
reformation after hysteroscopic lysis of intrauterine for upto 7 days during re-epithelization. Tsapanos et al 60
adhesions.The introduction of an IUD may also carry a reported on a randomized, controlled trial to evaluate the
small risk of perforation of the uterus. safety and efficacy of Seprafilm in preventing and reducing

Foley catheter: Several studies have reported on the use of postoperative endometrial synechiae formation after suction
a Foley catheter introduced into the uterine cavity with an evacuation or curettage for incomplete, missed and recurrent
inflated balloon for several days after lysis of adhesions to abortion. In the Seprafilm-treated group, 10% developed
prevent recurrence. The use of balloon to prevent adhesion intrauterine adhesions; whereas in the control group, 50%
formation after adhesiolysis maintains the freshly separated developed intrauterine adhesions.
uterine cavity by separating the opposing uterine walls. In Hormone treatment: Many gynecologists do use estrogen
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2003, Orhue et al demonstrated that the Foley catheter therapy after hysteroscopic lysis of intrauterine adhesions
was a safer, more effective method for preventing but its use has not been universally accepted as there has
reformation of intrauterine adhesions after adhesiolysis. been no objective evidence based on randomized, controlled
Furthermore, in a prospective controlled study, Amer
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et al assessed the efficacy of an intrauterine balloon in trials to confirm the efficacy of estrogen treatment on the
reduction of reformation of intrauterine adhesions.
preventing intrauterine adhesions after operative
hysteroscopy. The investigators concluded that its OUTCOMES OF TREATMENT
application after operative hysteroscopy is of great value in
preventing intrauterine adhesions. Amer and Abd-EI- Surgical success can be judged by the restoration of normal
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Maeboud had tried amnion grafts after hysteroscopic lysis anatomy in the uterine cavity. The rate of successful
of intrauterine adhesions. In a pilot study, involving anatomic restoration in a first procedure has been reported
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25 patients with moderate or severe intrauterine adhesions, to range from 57.8 to 97.5%. However, even when the
hysteroscopic adhesiolysis was followed by intrauterine uterine cavity has been restored anatomically, the extent of
application of a fresh amnion graft over an inflated Foley endometrial fibrosis will determine the reproductive
catheter balloon for 2 weeks. Second-look hysteroscopy outcome. Hence, the restoration of both uterine anatomy
revealed adhesion reformation in 48% of the patients who and the function of the endometrium are equally important.

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