Pos toperative Management of Recons tructive Surgeries

Sometimes, in the course of treating infertility, it is necessaryto perform recons tructive surgeries to correct some of the causesof infertility. Hydrosalpinx and ismosele can be mentionedamong these disorders.In patients with identified hydrosalpinx, implantation and pregnancyrates are significantly lower than in patients sufferingfrom other types of tubal injuries. Hydrosalpinx is used for any obs truction of the dis tal tubules. Regardless of the cause, itmeans that a non-tubular infection such as adjacent appendicitiscan also cause hydrosalpinx. Obviously, laparoscopy is the ultimatemethod for diagnosing hydrosalpinx and pelvic adhesionrelatedpathology, however, this method is very invasive andshould be used when necessary. Therefore, inves tigation andtreatment of hydrosalpinx helps to successfully treat infertilityand increase the chance of pregnancy.Ismocele is a diverticulum secondary to cesarean scar and can beseen in the form of a sac on the anterior walls of the uterus in thecervical canal. The firs t method of examining transvaginal ultrasoundis at the end of the proliferative phase. Hys tersonography(SIS) is the bes t examination method, which has more qualityand accuracy than transvaginal ultrasound. If the thickness of themyometrium in front of the defect is less than or equal to ۲.۲ inTVS ultrasound and less than or equal to ۲.۵ in SIS, the defect(ismosele) is considered large. Ismosele can be asymptomatic oraccompanied by symptoms such as pelvic pain, long-term spotting,secondary infertility and affects the quality of life. Amongthe problems caused by ismosele, we can mention implantationin the scar site of previous cesarean section, abnormal replacementof the placenta, accreta, damage to the bladder, bleedingand premature delivery. Therefore, inves tigation and treatment ofthis issue is necessary. The choice of surgical method depends onthe sonographic characteris tics of the lesion, symptoms, and thepatient's desire to become pregnant in the future. Improvement ofpain and bleeding symptoms of patients after hys teroscopic andlaparoscopic surgery has been reported up to ۸۵%.In this lecture, we will discuss the pos toperative management ofrecons tructive surgeries.