When Initial Hysteroscopic Adhesiolysis for Asherman's Syndrome Fails to Restore the Uterine Cavity
Intrauterine adhesions do not always resolve fully after a first attempt at hysteroscopic lysis. When the initial surgical approach under direct vision does not meet its clinical objectives, a defined next-line course of action is available.
Previous treatment & why it was insufficient
The prior line — hysteroscopic lysis of adhesions by direct vision using mechanical instruments (such as scissors or needle division), or with electrosurgical or laser instruments — did not achieve restoration of the normal volume and shape of the endometrial cavity and cervical canal, or resumption of normal menstrual flow.
Next-line approach
This step calls for hysteroscopic adhesiolysis carried out by a hysteroscopist with specialist-level expertise in advanced techniques, supported by specific adjunctive procedural guidance — the complete structured regimen is available via the link below.
References
DOI: 10.1016/j.jmig.2016.11.008
- In the presence of extensive or dense adhesions, treatment should be performed by an expert hysteroscopist familiar with at least one of the methods described.
- Adjunctive interventions to aid adhesiolysis include ultrasound, fluoroscopy, and laparoscopy.
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