A SCOTTISH AUDIT OF HYSTEROSCOPIC SURGERY FOR MENORRHAGIA - COMPLICATIONS AND FOLLOW-UP

Objective To evaluate the efficacy and safety of hysteroscopic surgery undertaken by a cross section of gynaecologists. Design A prospective registration of cases of hysteroscopic surgery by gynaecologists. Pat ient satisfaction was assessed at six and twelve months post-operative ly by postal questionnaire. Setting Thirteen hospitals in seven Scotti sh Health Boards. Secretariat in Aberdeen Royal Infirmary. Subjects Wo men having hysteroscopic surgery for menstrual problems. Interventions A few questions were added to the proforma during the audit. Results Between December 1991 and December 1993, 978 cases were registered. Co nsultants performed the majority of procedures. Complications occurred in 12% of cases and included one death from toxic shock syndrome. Ute rine perforation and significant fluid overload occurred in 1% of case s. To date, 732 women have been followed up at six months, 554 at twel ve months and 80 at 24 months. Eighty-four percent of those returning their questionnaires were satisfied or very satisfied at twelve months . By twelve months, repeat procedures had been performed in 13% and hy sterectomy in 11%. Sixty-six percent of women with a paid job had retu rned to work within two weeks and 88% within four weeks. Conclusions O verall, hysteroscopic surgery had a low rate of morbidity and satisfac tory efficacy with rapid post-operative recovery. Gynaecologists who h ave shown caution with the advent of this surgery can now be encourage d to take up endometrial ablation for dysfunctional uterine bleeding. Clinical guidelines are currently being prepared.