Pregnancy after Tompkins metroplasty for Robert's uterus

Area of Science:

• Reproductive Medicine
• Gynecological Surgery
• Adolescent Gynecology

Background:

• Primary dysmenorrhea resistant to medical treatment requires further investigation.
• Congenital uterine anomalies, such as uterine septa with unilateral obstruction, can cause severe dysmenorrhea.
• Accurate diagnosis often relies on advanced imaging like MRI scans.

Purpose of the Study:

• To report the novel application of Tompkins metroplasty for treating medically resistant primary dysmenorrhea caused by an asymmetric uterine septum.
• To evaluate the efficacy of this technique in resolving symptoms and improving reproductive outcomes.

Main Methods:

• Two adolescent patients with medically resistant primary dysmenorrhea underwent MRI, confirming asymmetric uterine septa with unilateral obstructed horns and hematometra.
• Both patients were treated with laparotomy and Tompkins metroplasty to unify the uterine cavity.

Main Results:

• Postoperative resolution of dysmenorrhea was observed in both patients.
• One patient achieved spontaneous pregnancy 3.5 years after surgery, delivering via emergency cesarean section at 36 weeks.
• This is the first reported pregnancy following Tompkins metroplasty for this condition.

Conclusions:

• Tompkins metroplasty is a viable surgical option for unifying uterine cavities in cases of asymmetric uterine septa causing severe dysmenorrhea.
• This technique offers an advantage by utilizing septal tissue in repair, potentially beneficial for thick septa.
• Early investigation with imaging is crucial for dysmenorrhea unresponsive to medical management.