Experience with the first 250 eridometrial resections for menorrhagia

• Published in: The Lancet (British edition) 1991-05, Vol.337 (8749), p.1074-1078
• Main Authors: Magos, A.L., Baumann, R., Lockwood, G.M., Turnbull, A.C.
• Format: Article
• Language: English
• Subjects: Anesthesia; Bleeding; Complications; Endometrium; Fibroids; Fibrosis; Hysterectomy; Menstruation; Patients; Perforation; Surgery; Tamponade; Uterus
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/0140-6736(91)91718-A

234 patients with menorrhagia were treated hysteroscopically by transcervical resection of the endometrium (TCRE) instead of hysterectomy. 250 procedures were performed under general anaesthesia (63%) or under sedation plus local anaesthesia (38%). The endometrium was excised either totally (91%) or partially (9%) in all but one case, and 56 (22%) of the patients underwent simultaneous resection of submucous fibroids. Surgical time (range 10-100 min) varied with the gynaecologist's experience. 479 ml was the average volume of uterine irrigant absorbed by the patient. Blood loss was usually slight. Operative complications were uncommon, but 4 (2%) women sustained a uterine perforation (without serious sequelae), 7 (3%) absorbed more than 2 litres of fluid, and 1 required tamponade to control postoperative bleeding. Hospital stay was short and full recovery usual by 1-2 weeks. Menstrual symtoms improved in over 90% of the patients throughout the follow-up of up to 2 1/2 years; 27-42% of the women became amenorrhoeic at some time after total TCRE. Results were best in women >35 years of age, but was not influenced by the presence of fibroids or pretreatment dysmenorrhoea. 10 (4%) women later underwent hysterectomy. Hysteroscopy 3 and 12 months after surgery revealed a small, fibrotic uterine cavity in the majority.