Incidence of postoperative intrauterine adhesions and septal remnants following hysteroscopic septum resection: A retrospective study

Objective To analyze the incidence and characteristics of postoperative intrauterine adhesions (IUAs) and septal remnants (SRs) following hysteroscopic septum resection performed without anti‐adhesion adjuvant therapies. Methods This retrospective cohort study included patients with a septate uterus (U2a/U2b, ESHRE/ESGE classification) who underwent hysteroscopic septum resection without anti‐adhesion adjuvant therapies between 2014 and 2023. Only patients with second‐look hysteroscopy performed within 1–6 months postoperatively were included. Patients with pre‐existing intrauterine adhesions, submucosal fibroids, prior septum resection, or adjuvant therapy use were excluded. Primary outcomes were the incidence, location, and type of postoperative IUAs and SRs. Results A total of 285 patients were included in the analysis. Postoperative IUAs were identified in two (0.7%) cases. SRs were observed in 98 (34.4%) patients, with 21 (7.4%) cases measuring <5 mm, 76 (26.7%) cases between 5–10 mm, and one (0.4%) case exceeding 10 mm. Among the 196 patients who attempted conception postoperatively, 161 (82.1%) achieved pregnancy. A total of 39 (24.2%) patients experienced miscarriage, three (1.9%) had an ectopic pregnancy, and live birth was achieved in 114 (58.2%) cases. Conclusion Hysteroscopic septum resection without anti‐adhesion therapies resulted in a low incidence of IUA and frequent SRs. Routine second‐look hysteroscopy may aid early detection and treatment. Further studies are needed to clarify its role in optimizing reproductive outcomes.