Extended balloon stent placement for reducing intrauterine adhesion recurrence: a retrospective cohort study

Research question To compare the efficacy, safety, and reproductive outcomes of intrauterine balloon stent placement for 4 and 6 weeks after hysteroscopic adhesiolysis. Design This retrospective cohort study was conducted at a university-affiliated hospital, and 155 women with moderate-to-severe intrauterine adhesions who underwent hysteroscopic adhesiolysis between March 2016 and December 2019 were included. Patients were divided according to whether the heart-shaped balloon stent was left in place for 4 (Group 1) or 6 weeks (Group 2) after surgery. Stents removed at the second-look hysteroscopy 4 or 6 weeks after surgery were sent for a culture of common bacteria. The incidence of adhesion reformation and adhesion score reduction, bacterial colonisation of the intrauterine balloon stent, live birth rate, and time to live birth were analysed. Results Group 2 had a significantly lower adhesion reformation rate (45.7% vs 28.2%, P=.024) and a more significant reduction in adhesion score (5.2 ± 2.1 vs 6.3 ± 2.2, P=.003) than Group 1. However, no statistical difference was observed in the percentage of bacterial colonisation of the intrauterine balloon stent (55.9% vs 66.7%, P=.174), live birth rate (52.4% vs 42.3%, P=.331), or time to live birth (hazard ratio: 1.09, 95% confidence interval: 0.60–1.96, P=.778) between the two groups. Conclusions Extending intrauterine balloon stent use from 4 to 6 weeks further reduces the adhesion reformation rate after hysteroscopic adhesiolysis in patients with moderate-to-severe intrauterine adhesion. No increase in bacterial colonisation of the balloon stent was observed. Extending the duration of intrauterine balloon stent placement did not significantly affect live birth rates.