OUTPATIENT HYSTEROSCOPIC ADHESIOLYSIS: CLINICAL AND MORPHOLOGICAL EVALUATION OF ITS EFFICACY

Introduction. Intrauterine synechiae (IUS) cause a wide range of reproductive possibilities. The development of modern adhesiolysis technologies is of great scientific and practical importance. Objective. Improvement of adhesion technology in outpatient settings using a small-diameter hysteroscope and pulsed diode laser energy in patients with Ascherman syndrome. Material and methods. A prospective comparative cohort study of 55 patients with Ascherman syndrome was conducted. They were divided into three groups depending on the technology and location of the synechiolysis. Group 1 (n=14) included patients who underwent intrauterine synechiae dissection on an outpatient basis using a minihysteroscope and pulsed diode laser energy, group 2 (n=30) included women who underwent outpatient surgery using a minihysteroscope and bipolar electricity. Group 3 (n=11) included patients who underwent BC destruction in an inpatient setting using a bipolar resectoscope. A comparative analysis of adhesiolysis effectiveness of the technology in outpatient hysteroscopy was carried out based on the quality of anesthetic care, the course of intrauterine intervention, the features of the course of the postoperative period, as well as the morphofunctional state of the endometrium. Results. The adhesiolysis technology in outpatient hysteroscopy allows the dissection of intrauterine adhesions in a gentle way – without dilating the cervical canal, with minimal intravasation of fluid into the uterine cavity, which reduces the severity of pain after surgery and contributes to normalization of menstrual function compared to patients treated inpatient with a bipolar resectoscope. Conclusion. The proposed technology makes it possible to perform adhesionolysis effectively and safely outpatiently. Morphofunctional changes in the endometrium, which persist after adhesiolysis, and the low pregnancy rate determine the need to use a complex of treatment and rehabilitation measures in the postoperative period to normalize the morphofunctional state of the endometrium.