Laparoscopic Strassman’s metroplasty for bicornuate uterus

Abstract

The authors report the case of a 28-year-old nulliparous woman with a bicornuate uterus and one previous second trimester pregnancy loss, in whom investigations for other probable causes of abortion like genetic, infective, hormonal, and immunological were negative. A laparoscopic metroplasty was performed by Strassman's method. Second-look hysteroscopy and laparoscopy, which was performed 7 months later, revealed a single uniform cavity with a median muscular ridge, which resembled an arcuate uterus. Pelvic adhesions were noted between the small bowel, omentum, and posterior wall of the uterus, along with pelvic endometriosis and a chocolate cyst of the left ovary. Adhesiolysis, cyst excision, and fulgration of endometriotic deposits were carried out, which were followed by the application of an adhesion barrier.

Laparoscopic Strassman’s metroplasty for bicornuate uterus – is it relevant?

“…9 It was followed by a series of other case reports showing good restoration of the uterine anatomy, minimal peritoneal adhesions, less blood loss, creation of a spacious uniform uterine cavity, shorter hospital stay and good scar integrity. 14,15 Our findings were similar, with the exception that we did not test scar integrity on follow-up.…”

Laparoscopic metroplasty for bicornuate uterus – A case report

“…7 Adhesions are further minimized by use of liquid agents like 4% Icodextrin solution or spraying with hydrogel barriers. 8 However, good suturing skills are required for ensuring complete hemostasis in laproscopy. Adequate care may be taken to ensure that the myometrial edges are not sutured under tension, as it is prone for hematoma formation.…”

Successful reproductive outcome after laparoscopic Strassmann’s metroplasty

“…[ 7 ] Following this, a series of other case reports had shown a good restoration of uterine anatomy, uniform cavity creation with good scar integrity, minimal adhesions, less blood loss, and shorter hospital stay. [ 8 9 ] An observational study, largest of its kind, that included women with double uterine cavities (bicornuate or didelphys) with a history of recurrent pregnancy loss evaluated the feasibility of laparoscopic metroplasty. Of 14 patients, 12 had conception, nine going till full term ending in caesarean section with normal pregnancy outcomes.…”