Septal Resection



Uterine septum is said if there is a division in the cavity of the uterus. It is the most common type of Mullerian anomaly, and occurs in 3%-7% of the general population.Septum can be complete or incomplete, however incomplete septum is more common.Septum is associated with the poor reproductive outcomes and is associated with recurrent pregnancy loss, preterm labor, malpresentation and intra uterine growth restriction. It is also seen in patients with unexplained infertility. The endometrium on the septum is thought to be different from the surrounding endometrium in the uterine cavity, it is believed to be the cause for failed implantation. However some women with septum can be asymptomatic and conceive and deliver spontaneously. But women with recurrent pregnancy losses do benefit with septal resection.


Diagnosis

Uterine septum is suspected in women with recurrent pregnancy loss or in women who fail to conceive. Imaging modalities that are used in the diagnosis of a uterine septum are hysterosalpingogram (HSG), ultrasound (2D and 3D), and MRI. However direct confirmation at hysteroscopy remains gold standard.


Treatment
Septal resection provides an opportunity to improve reproductive and obstetric outcomes in women with bad reproductive outcomes and are diagnosed to have a septum. 

Earlier the treatment was with an open surgery and was a major procedure. With advancement in hysteroscopic technology, septoplasty is a simple procedure today with decreased morbidity. The procedure has proven to be safe and effective for women with a history of recurrent miscarriage and other poor reproductive outcomes. In the hands of experienced gynecologic surgeons, this procedure has low rates of intraoperative complications and postoperative sequelae. Some of the potential intraoperative complications can be bleeding, distention media overload, and perforation. Intra uterine adhesions can be delayed complications of hysteroscopicseptoplasty. However these complications are less than 1% in centers and surgeons with adequate experience. We at Apollo Hospitals exclusively manage uterine septum with advanced hysteroscopy surgeries.


Hysteroscopy surgery involves incising the uterine septum and this is done with either microscissors or electrosurgery. The use of microscissors, an energy-free technique, is more beneficial as it prevents intrauterine adhesions due to less thermal damage to the surrounding endometrium.Concomitant laparoscopy is also often done. Laparoscopy can confirm the diagnosis of septum. External appearance is of septate uterus is a broad fundus and can help in differentiating from bicornuate uterus. Laparoscopy can also provide a guide to the extent of septal resection to be done and can help prevent or diagnose complications such as perforation of the uterus. As blanching of the uterine serosa or visualization of the hysteroscopic light can give an idea regarding the proximity to the serosal surface. Coexisting pelvic pathology like endometriosis, adhesion or altered tubo ovarian anatomy also can be diagnosed and treated in the same surgery.




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