Operative hysteroscopy
Endouterine Synechiae and Hysteroscopic Synechiolysis
Asherman's syndrome (intrauterine adhesions) is a condition caused by repeated trauma to the endometrium that lines the walls of the uterine cavity and leads to the formation of adhesions within the uterus. These adhesions cause amenorrhoea (absence of menstruation) and temporary or permanent loss of fertility.
Causes:
1) R.C.U. (curettage) for postpartum or puerperium haemorrhage, miscarriage, internal especially if repeatedly performed with both metal curettes and suction
2) examination of peri- and postmenopausal cavities
3) I.V.G. (voluntary termination of pregnancy)
4) post-partum or post-abortion chorioplacental residues
5) endometritis
Genesis:
1) traumatic (destruction of the endometrium and removal of the basal layer)
2) inflammatory (retention of chorioplacental remnants and simultaneous phenomena of inflammation and necrosis of the same)
3) operative hysteroscopies for submucosal myomas, endometrial ablation or metroplasty especially if poorly executed or with complications
4) previous caesarean section, laparoscopic or laparotomic myomectomies
Ashermann syndrome can present itself with various types of severity ranging from a single, simple adhesion to the involvement of the entire uterine cavity
Diagnosis clinic:
- Amenorrhoea, hypomenorrhoea, dysmenorrhoea, pelvic pain
- Sterility following curettage
- Haematometry (collection of menstrual blood inside the uterus) after a curettage
Instrumental diagnosis:
- Idiagnostic steroscopy which allows a direct view of the uterine cavity with diagnosis of the presence and extent of adhesions. Hysteroscopy is the examination that gives absolute certainty of the syndrome
- Ultrasound plays an important role during surgery to guide the operator to follow the right direction and decrease the risk of perforations.
Operating technique
It differs depending on the type and severity of the syndrome. Usually mechanical instruments are used (micropliers to find the right path and microscissors to cut the synechiae)
In our large case series, only one patient has recovered neither her period nor her fertility after five operations. However, the pelvic pains disappeared. All the others got their periods back even after two and a half years of amenorrhoea and carried their pregnancies to term where desired.
English 
Italian