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

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.