TRANSCERVICAL HYSTEROSCOPIC RESECTION OF SUBMUCOUS FIBROIDS FOR ABNORMAL UTERINE BLEEDING - RESULTS REGARDING THE DEGREE OF INTRAMURAL EXTENSION

Objective: To examine the results of transcervical resection of submuc ous fibroids in relation to the degree of intramural extension. Method s: A prospective 3-year observational study was performed of transcerv ical resection of submucous fibroids for abnormal uterine bleeding. Th e mean follow-up was 20 months (range 10-34). Fifty-one patients with a mean age of 38 years (range 23-55) were treated with transcervical r esection after classification according to the degree of intramural ex tension of the submucous fibroids. The intention was to perform comple te resection, established at control hysteroscopy. A repeat procedure was performed in cases of incomplete resection unless the patient deni ed further hysteroscopic treatment. Outcome measures were control of b leeding, subsequent surgery, number of procedures, number of complete resections, and number of recurrences. Results: Bleeding was controlle d in 48 (94.1%) of all patients after final resection. Hysterectomy wa s performed in three patients (5.9%) because of persistent complaints: in two cases after incomplete resection and in one case after complet e resection. Three patients were lost to follow-up. Of the remaining 4 5 patients (42 with complete and three with incomplete final resection ), three (6.7%) had a recurrence (one after complete and two after inc omplete final resection). With more extensive intramural involvement, the chance to achieve complete resection decreased and the mean number of procedures to achieve complete resection increased. Conclusions: C omplete resection improves the long-term results of transcervical rese ction of submucous fibroids for control of abnormal uterine bleeding. Transcervical resection of submucous fibroids with more than 50% intra mural extension should be performed only in selected cases, as complet e resection usually necessitates repeat procedures.