Transcervical endometrial resection: Long-term results of 390 procedures

Background. Hysteroscopic transcervical resection of the endometrium and submucous fibroids has been performed to treat excessive uterine bleeding as an alternative to hysterectomy. The present study aims to evaluate the treatment effect of this procedure at our department. Methods. Retrospective record review and a questionnaire 4 - 10 years after surgery. Patients' characteristics, symptoms, medical treatment prior to surgery, uterine size, weight of resectate, blood loss, glycine loss, operative time, complications, procedures per surgeon, indications, frequency and time to hysterectomy, dysmenorrhea related to prior tubal ligation, the presence of adenomyosis related to later hysterectomy, and patient satisfaction. Results. In the period 1992 - 1998, 386 patients had 390 procedures performed by six different surgeons. 49.5% of patients had fibroids and 46.9% had a prior tubal sterilization. During operations, 6% had a hemoglobin loss of more than 2.5 g/dl, and 2.1% had a glycine loss of more than 1.5 l. Uterine perforations were encountered in 31 cases (8%), of which only 2 led to a laparotomy. During the time of follow-up of 4 - 10 years, 16.6% of patients had a hysterectomy, usually because of pain or bleeding, and 50% of these were done within 2 years after the initial hysteroscopic procedure. Malignancy was found in the resectate in 6 of the patients (1.5%) despite a normal preoperative cytological or histological endometrial sample, and all these had a hysterectomy. Adenomyosis was not related to later hysterectomy and dysmenorrhea did not seem to increase after the procedure. Conclusions. For 83.4% of the patients, the problem of uterine bleeding was solved by the hysteroscopic resection, and major surgery was avoided. Long-term results did not correlate to surgeon's experience. Patient satisfaction was high.