ENDOMETRIAL ND-YAG LASER-ABLATION BY HYSTEROFIBROSCOPY - LONG-TERM RESULTS OF 137 CASES

Objective: In our gynecology department, we have been performing endom etrial laser ablation (ELA) under video control using a flexible hyste roscope since 1989. The aim of this study is to evaluate the long term results of our experience. Study, design: We went back to the files o f 137 patients treated between 1989 and 1993. These women (mean age 42 years) exhibited menorrhagia unamenable to medical treatments which h ad been developing for 28 months. Mean hysterometry was 9.8 cm. A hyst eroscopy with ELA was performed. Our procedure lasts 19 min on average and uses 0.9 1 of glycocol. There were no perforations. Six patients presented a fever above 38 degrees C within the next 48 h; only one de veloped a true endometritis necessitating antibiotherapy. One patient who had received several GnRH agonist courses had a coagulation of the uterus and had to be hysterectomised. Results: Nine patients were los t to follow-up; for the others, mean follow-up was 32 months. Seventee n women (13.3%) were hysterectomised, including the patient with a coa gulation necrosis of the myometrium. In most cases, this was for undet ected adenomyosis or fibromas evolving after hysteroscopy. Bleeding re curred in two other patients; they refused hysterectomy but should be counted as failures of this method. Among the 109 patients (85.1%) con sidered a success, 35 have had menopause since the procedure. Conclusi on: ELA is a simple quick procedure which significantly reduces the nu mber of hysterectomies. In addition, the economic value of ELA is begi nning to be assessed in the literature. This long-term study should al low the indications to be better defined by eliminating patients with a high risk of failure and should lead to improved results.