TRANSCERVICAL ELECTROSURGICAL RESECTION OF SUBMUCOUS LEIOMYOMAS FOR CHRONIC MENORRHAGIA

Study Objective. To evaluate the effectiveness and safety of transcerv ical electrosurgical resection (TSR) of submucous leiomyomas with or w ithout concomitant transcervical endomyometrial resection (TEMP) for c hronic menorrhagia. Design. Prospective observational study, with 6-mo nth follow-up of all 208 women and up to 6-year follow-up of 185 (88.9 %). Setting. Gynecology departments of teaching, community, and propri etary hospitals. Patients. Two hundred eight women with submucous leio myoma requiring surgical treatment of menorrhagia between March 1988 a nd March 1994. Interventions. All 208 women (age range 32-63 yrs) unde rwent TSR with a continuous-flow gynecologic resectoscope. In 88 of th ese women who had no desire to preserve fertility concomitant TEMR was performed. Measurements and Main Results. Six months postoperatively 113 (94.2%) of the 120 women who underwent only TSR reported normal me nses and 85 (96.6%) had satisfactory results; 62 (70.5%) who had both TSR and TEMR were amenorrheic. Eleven (73%) of the 15 women who had TS R and wanted to conceive subsequently became pregnant. One hundred eig hty-five (88.9%) of the 208 patients have been followed for as long as 6 years. Ninety (84.1%) of the 107 women who had only the initial TSR and 69 (88.5%) of the 78 who had initial TSR and TEMR had satisfactor y results. Only five women (2.7%) required major abdominal surgery. Am ong those undergoing TSR and TEMP, 49 (62.8%) were amenorrheic for as long as 6 years after TSR and one or two TEMRs. Eight (3.8%) of the 20 8 women had perioperative complications: 6 (2.9%) had fluid overload, 1 (0.5%) had dilutional hyponatremia, and 1 (0.5%) had excessive posto perative bleeding requiring tamponade.Conclusions. We believe that TSR with or without concomitant TEMR is an effective and safe treatment f or women with submucous leiomyomas suffering from chronic menorrhagia.