Clinical efficacy analysis of LNG-IUS tail anchoring to the superficial myometrium under hysteroscopic direct vision

Abstract

Objective: To investigate the clinical efficacy of levonorgestrel-releasing intrauterine system (LNG-IUS) tail anchoring to the superficial myometrium under hysteroscopic direct vision.

Methods: From March 1, 2017, to March 1, 2022, 206 patients at the Third Xiangya Hospital of Central South University who had a history of at least one LNG-IUS expulsion and who required replacement of the LNG-IUS were retrospectively analyzed. Patients were divided into a common placement group and an anchoring group according to the placement method used for the LNG-IUS. Between-group comparisons of the re-expulsion rate and adverse reactions were performed, and the clinical efficacy of anchoring was evaluated. The patients in the anchoring group were divided into short-tail and long-tail groups on the basis of the length of the tail.

Results: After propensity score matching (PSM), the re-expulsion rate was 18.87% for the anchoring group and 43.40% for the common placement group. There was a significant difference in re-expulsion rates between the two groups (P< 0.05), with the anchoring group having a significantly lower rate than the common placement group. Additionally, the re-expulsion rate of the long-tail group (6.90%) was significantly lower than that of the short-tail group (28.77%) (P< 0.05). The use of anchoring surgery did not lead to a higher incidence of uterine perforation or infection.

Conclusions: For patients with a history of levonorgestrel-releasing intrauterine system expulsion, anchoring the LNG-IUS tail in the superficial uterine myometrium under hysteroscopy can effectively prevent re-expulsion and significantly reduce the re-expulsion rate, especially when the long tail anchoring method is used. This technique is efficacious and warrants widespread adoption.

Keywords: Anchoring surgery; Clinical efficacy; Expulsion; LNG-IUS.

Fig. 1

Surgical illustration of anchoring surgery. A LNG-IUS in normal position; B The tail of LNG-IUS submerged from the lateral wall of the uterus from the bottom to the top; C Tying and fixing of the tail that comes out of the upper segment of the uterine sidewall

Fig. 2

Surgical video illustration of anchoring surgery. (A The distal end of the tail (approximately 5–10 cm from the external cervical opening) was grasped with a 5 Fr single-jointed forceps, entered the uterine cavity. B The starting position is the middle and lower part of the left or right wall of uterus. C The tail of LNG-IUS submerged through the superficial muscularis propria from the middle and lower part of the left or right wall of uterus from bottom to top, and the sneak distance is about 1.5–2.5 cm. D The tail of LNG-IUS passed through the upper end of the lateral wall. E Pull down and adjust the position of the tail of LNG-IUS. F The tail of LNG-IUS wire is knotted and fixed)