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Tuesday 1 January 2019

Value of herbal medicine in prevention of postoperative intrauterine adhesions (Misurata experience)


Objective

Intrauterine adhesions (IUAs) are the major long-term complications of operative hysteroscopy(OH). It may result in poor reproductive outcomes, menstrual abnormalities and pelvic pain. Several methods have been tried to prevent post-surgical IUAs but all without significant benefits. Moist exposed burn ointment (MEBO) is a herbal product, containing phytosterols with anti-inflammatory, anti-bacterial and analgesic effects mainly used for wound healing and management of burns and ulcers, such properties might be useful to avoid IUAs, therefore, aim of this study is to assess the efficacy and safety of MEBO in prevention of de novo IUAs following OH.

Design

A randomized controlled University hospitals-based study.

Materials and Methods

Selected 72 patients during a period of 12 months were enrolled in this study. Inclusion criteria: hysteroscopic diagnosis of submucous myomas, polyps, uterine septa or DUB requiring endometrial resection. Exclusion criteria were: age > 50, obesity, pregnancy, prolapse, malignancy, and presence of IUAs. Patients were randomized into 2 groups, and without significant differences in age, weight, uterine size and party. Group (A) of 40 patients underwent hysteroscopic surgery(HS) plus intrauterine application of MEBO. Group (B), the remaining 32 patients, underwent (HS) only (control). Follow-up diagnostic hysteroscopy was performed for each patient, 6 weeks later. Adhesion score assessment according to the American Fertility Society (AFS) classification system. Statistical analysis performed using SPSS package. P-value considered to be significant if (< 0.05).

Results

Eleven women ( 4 from group A & 7 from group B) did not attend for follow-up. At 6 weeks follow-up, a highly significant lower rate of post-surgical IUAs was found in group (A): only one out of 36 women compared with group (B): 8 out of 25 patients {2.8 % versus 32 % ; P < 0.05}. Evaluation of IUAs staging by AFS system, showed a significant decrease in adhesions severity in the patient from group A ( stage I ) when compared with women from group B: 6 patients (stage II) & 2 patients (stage III ){P < 0.05}. No complications or adverse MEBO-related effects were detected in group A patients.


Conclusions

(MEBO), is safe, non-expensive and with a highly significant reduction rate in the incidence and severity of de-novo formation of IUAs after HS.