Surgical approach to and reproductive outcome after surgical correction of a T-shaped uterus


 Literature Review Article

 Surgical approach to and reproductive outcome after surgical correction of a T-shaped uterus. Fernandez H, Garbin O, Casaigne V, Gervaise A, Levaillant JM. Hum Reprod. 2011; 26(7): 1730-4. 

Dr. John Preston Parry, M.D., M.P.H.

The goal of this study is to address surgical correction of the T-shaped uterus and the effect on subsequent reproductive outcomes. 97 women participated in the study, of which 63 had previous DES exposure. The authors emphasize the importance of proper preoperative diagnosis prior to surgery and particularly recommend 3D ultrasound (or MRI). Both monopolar and bipolar techniques were used to incise in the lateral walls up to a depth of 5 to 7 mm so as to create a triangular and symmetric uterine cavity. This was a population prone to selection bias, as reflected by a pretreatment live birth rate of 0%. After treatment, the miscarriage rate was 26.9%, the preterm delivery rate was 19.2%, and the term delivery rate was 53.8%. With repair, the authors noted 6% of patients needed repeat surgery for synechiae or to complete the procedure and there was a 1% rate of uterine perforation. The authors conclude that women with a T-shaped uterus and previous adverse reproductive outcomes are likely to have a favorable live birth rate after this procedure.

Dr. Steven R Lindheim, M.D., M.M.M.

This paper presents an interesting surgical approach using mono and bipolar cautery in contrast to previous scissors repair  in the correction of the T-shaped mullerian anomaly where several studies have showed  poor reproductive performance. While overall outcomes produced good anatomical results noted on 2nd look hysteroscopy in most cases: Five required follow-up surgery to correct synechiae or incomplete correction and a RCT is warranted to further validate its efficacy.  

The above review and commentary on this article were written by SRS members. Publication of these summaries does not reflect endorsement of any particular procedure or treatment. Views expressed in these summaries do not necessarily reflect the views of SRS or ASRM.



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