Abstract: Objective To explore the efficacy of hysteroscopic Intrauterine Bigatti Shaver (IBS) in treating severe intrauterine adhesion (IUA) and the therapeutic outcomes of IBS combined with different anti-adhesion methods. Methods Retrospective analysis was conducted on the clinical data of 86 patients with severe IUA who were treated in Department of Gynecology, the Affiliated Hospital of Xuzhou Medical University from January 2018 to May 2024. Among them, 48 patients underwent hysteroscopic IBS surgery (IBS group), and 38 patients underwent hysteroscopic electrosurgery (electrosurgery group). The clinical data of the two groups were compared. According to postoperative anti-adhesion methods, the IBS surgery group was further divided into three subgroups: group A (sodium hyaluronate), group B (sodium hyaluronate + estrogen and progesterone), and group C (sodium hyaluronate + intrauterine device (IUD) + estrogen and progesterone). The clinical data of the three groups were compared. A logistic regression model was established to analyze the influencing factors of postoperative efficacy in severe IUA patients treated with hysteroscoptic IBS. Results There were no statistical differences between the IBS group and the electrosurgery group in terms of age, history of abortion/intrauterine surgery, preoperative American Fertility Society (AFS) score, operation duration, and average intraoperative blood loss (P>0.05). In terms of postoperative improvement in menstrual volume, the total effective rate of the IBS group (68.8%) was superior to that in the electrosurgery group (47.4%) (P<0.05). Among the IBS group patients treated with different anti-adhesion methods, there were no significant differences in age, preoperative AFS score, operation duration, or intraoperative blood loss among groups A, B, and C (P>0.05). However, group C showed better improvement in postoperative menstrual volume, compared with groups A and B (P<0.05). Multivariate logistic regression analysis showed that a long disease duration (>1 year) and thin endometrial thickness after treatment (≤0.6 cm) were independent risk factors that affect the postoperative efficacy of hysteroscopic IBS for severe IUA. Postoperative oral estrogen-progestin and intrauterine placement of an IUD were beneficial for symptom improvement (P<0.05). Conclusions Hysteroscopic IBS is effective in treating severe IUA. The combination of sodium hyaluronate, IUD, and estrogen and progesterone postoperatively can enhance the therapeutic outcomes.