Treatment of Asherman's Syndrome (Intrauterine Adhesions)
Asherman's syndrome is characterised by intrauterine adhesions (IUAs) that distort the endometrial cavity and cervical canal. The structured protocol below addresses surgical management directed at restoring normal uterine anatomy and function.
Clinical Goals
The primary objective is restoration of the normal volume and shape of the endometrial cavity and cervical canal, facilitating communication between the cavity, the cervical canal, and the fallopian tubes — enabling resumption of normal menstrual flow.
Treatment Approach — Partial Summary
The recommended approach involves direct-vision hysteroscopic surgery to lyse intrauterine adhesions, with instrument selection guided by evidence around preserving endometrial integrity. The complete protocol specifies which instruments are preferred, which carry specific cautions, and the full procedural algorithm.
References
DOI: 10.1016/j.jmig.2016.11.008
- Hysteroscopic lysis of adhesions by direct vision and a tool for adhesiolysis is the recommended approach for symptomatic IUAs.
- Mechanical division of adhesions by scissors and needle are described as modes of surgical treatment.
- Indirect evidence exists to avoid electrosurgery during adhesiolysis owing to the potential risk for further endometrial damage.
- Monopolar and bipolar electrosurgical instruments and the Nd-YAG laser have been described as techniques used to lyse adhesions under direct vision, with the advantages of precise cutting and good hemostasis.
- The primary objective of any intervention is to restore the normal volume and shape of the endometrial cavity and cervical canal and to facilitate communication between the cavity and both the cervical canal and fallopian tubes.
- This will allow both normal menstrual flow and adequate sperm transportation for fertilization and implantation to occur.
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