Incidence of postoperative intrauterine adhesions and septal remnants following hysteroscopic septum resection: A retrospective study.

OBJECTIVE

To analyze the incidence and characteristics of postoperative intrauterine adhesions (IUAs) and septal remnants (SRs) following hysteroscopic septum resection performed without anti-adhesion adjuvant therapies.

METHODS

This retrospective cohort study included patients with a septate uterus (U2a/U2b, ESHRE/ESGE classification) who underwent hysteroscopic septum resection without anti-adhesion adjuvant therapies between 2014 and 2023. Only patients with second-look hysteroscopy performed within 1-6 months postoperatively were included. Patients with pre-existing intrauterine adhesions, submucosal fibroids, prior septum resection, or adjuvant therapy use were excluded. Primary outcomes were the incidence, location, and type of postoperative IUAs and SRs.

RESULTS

A total of 285 patients were included in the analysis. Postoperative IUAs were identified in two (0.7%) cases. SRs were observed in 98 (34.4%) patients, with 21 (7.4%) cases measuring <5 mm, 76 (26.7%) cases between 5-10 mm, and one (0.4%) case exceeding 10 mm. Among the 196 patients who attempted conception postoperatively, 161 (82.1%) achieved pregnancy. A total of 39 (24.2%) patients experienced miscarriage, three (1.9%) had an ectopic pregnancy, and live birth was achieved in 114 (58.2%) cases.

CONCLUSION

Hysteroscopic septum resection without anti-adhesion therapies resulted in a low incidence of IUA and frequent SRs. Routine second-look hysteroscopy may aid early detection and treatment. Further studies are needed to clarify its role in optimizing reproductive outcomes.