Page 22 - World Journal of Laparoscopic Surgery

A 3 Years Review of Hysteroscopy in a Private Hospital in Nigeria

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A 4 mm 0 rigid telescope was used. The hysteroscopic Table 3: Findings at hysteroscopy
procedures were carried out during the proliferative phase of 3A: Si ngle path ology
the patients’ menstrual cycle. All but nine patients had Pathology n %
paracervical block with xylocaine in addition to intravenous IUA only 25 28.7
pentazocine and promethazine for pain relieve. The nine patients Endometrial polyp 10 11.5
had general anesthesia as they had combined hysteroscopy Bone pieces 3 3.5
and laparoscopy. Normal saline was used as distention medium. Cervical stenosis 3 3.5
Therapeutic procedures were performed with hysteroscopic Submucous fibroid 2 2.3
grasping forceps and scissors. False passage 1 1.1
Total 44 50.6
RESULTS
3B: Mult i ple pat h ologies
A total of 87 hysteroscopies were carried out during the period Pathology n %
under review. Eighty-five (97.7%) patients presented with
infertility. The parity ranged from 0-5. Table 1 shows the age IUA and polyp 8 7 9.2
8.1
IUA and cervical stenosis
distribution of the patients. The age range was 24-47 years Cervical stenosis and Endo. polyp 5 5.7
(35.5 ± 4.7). Majority of the patients were aged between 35 and IUA and uterine perforation 3 3.5
39 years (39.1%). As shown in Table 2, sixty three (72.4%)
patients were nulliparous. Among the nulliparous patients, 14 Total 23 26.5
(22.2%) had primary infertility. Seven of the fourteen patients IUA = Intrauterine adhesions
(50%) had intrauterine adhesions at hysteroscopy. Endo. polyp = Endometrial polyp
Twenty patients (23%) had normal hysteroscopic findings. Table 4: Hysteroscopic procedures
As shown in Table 3, forty-four (48.3%) patients had single
pathology while 23 (26.4%) had multiple pathologies. The Procedure n %
commonest pathology was intrauterine adhesions (43 or 64.2%). Adhesiolysis 43 67.2
There were 3 (3.5%) cases of retained fetal bones within the Polypectomy 23 35.9
endometrial cavity. Table 4 shows the different hysteroscopic Cervical dilatation 15 23.4
procedures carried out. Sixty-four (73.6%) patients underwent Removal of bone piece 3 1 4.1
1.6
Submucous myomectomy
hysteroscopic surgical procedures. The commonest procedure
performed was adhesiolysis (43 or 67.2%) followed by involved a 33 years old woman who developed apnea following
polypectomy (23 or 35.9%). While 21 (48.8%) patients had an completion of the procedure under general anesthesia.
intrauterine contraceptive device (IUCD), 4 (9.3%) had Pediatric
Foley’s catheter inserted following adhesiolysis. One DISCUSSION
complication (1.2%) occurred during the study period and
During the last few years, diagnostic hysteroscopy has become
a standard procedure in the diagnosis of fertility disorders,
Table 1: Age distribution of patients
abnormal uterine bleeding and sonographically suspicious
Age (years) n % 4
endometrial reflection. Today, hysteroscopic resection of
20-24 1 1.1 uterine myomas, dissection of uterine septa and endometrial
4
25-29 10 11.5 ablation are standard procedures. Performed concomitantly
30-34 24 27.6 with laparoscopy, hysteroscopy becomes the most effective
35-39 34 39.1 technique for evaluation of the uterine and tubal conditions
that may play a role in female fertility. 5
> 40 18 20.7
As would be expected being a fertility center, majority of
Total 87 100 the patients were nulliparous (72.4%). Of the 2 patients who did
not present with infertility, 1 presented with dysfunctional
Table 2: Parity distribution of patients
+1
uterine bleeding. She was a 38 years old para 4 lady who had
Parity n % normal findings at hysteroscopy. The other was a 44 years old
0 63 72.4 para 5 +3 lady who presented with recurrent spontaneous
1 15 17.2 miscarriages. Hysteroscopy showed minimal uterine adhesions
2-4 6 6.9 which would not account for the miscarriages. Cervical os
> 5 3 3.5
appeared intact and a chromosomal cause was suspected. Being
Total 87 100 advanced in age and a grandmultipara she was equally

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