Comparison between abdominal and hysteroscopic metroplasty

Thirty-three patients were diagnosed by hysterosalpingography and laparoscopy as having septate uteri, which were assumed to be responsible for their infertility, recurrent abortions, or premature labor. Fourteen of these had Tompkins metroplasty (group 1) while the other 19 had their repairs done by hysteroscopic metroplasty (group 2). Post-operative hysterosalpingography for patients in group 1 revealed normal uterine cavities in 72%, incomplete septum excision in 14%, and intrauterine filling defects in 14%. The corresponding figures in group 2 were 88, 12, and 0%. In group 1, 71.0% became pregnant; of these, 70% continued to term (with delivery by cesarean section), 20% aborted, and 10% were tubal pregnancies. In group 2, 84% became pregnant; of these, 87% had term vaginal deliveries, and 13% miscarried. Patients in group 2 had less operative time, less blood loss, and shorter hospital stays. These findings demonstrate that hysteroscopic metroplasty may be preferable to the transabdominal procedure based on cost and morbidity considerations as well as on anatomic and reproductive outcome.