Post-operative assessment

Evaluation of uterine cavity after adhesiolysis is an important step in AS management. As mentioned before, complete resolution of the adhesions is not always possible with a single procedure, especially in severe stages where a high recurrence rate is documented. For instance, Valle and Sciarra reported a 50% and 21.6% of recurrence in severe and moderate AS respectively. Timely recognition of any recurrence of adhesions is essential to provide the best prognosis, therefore it may be necessary to repeat surgery. For this reason, most treatment protocols include a follow-up to assess endometrial restoration after the surgery. If this is not done, there is evidence of an increased obstetric risk. Although the restoration of menses is considered a good marker of success, other diagnostic investigations are fundamental for an exhaustive evaluation.

Presently, there is no clear consensus about follow up management. Usually, post-treatment assessment of the uterine cavity is recommended one-two months after the initial surgery. Ultrasound, HSG and hysteroscopy are the most common follow-up methods.

Ultrasound is an accurate and cost-effective tool for measuring endometrial thickness and for the evaluation of normal endometrial development during menstrual cycle. HSG has the advantage to check tubal patency, and at the same time it can help in the resolution of thin adhesions from pressure of the liquid contrast medium. Hysteroscopy, however, remains the only method which allows an accurate estimation of adhesion recurrence and it is the most commonly used in clinical practice. Of course, it also allows further in office adhesiolysis.

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