HYSTEROSCOPIC ENDOMETRIAL ABLATION TO AVO ID HYSTERECTOMY IN HIGH-RISK PATIENTS

Hysteroscopic endometrial ablation under maximal anaesthesiological su rveillance was performed in 34 high-risk patients to avoid hysterectom y. It was a collective of patients with heavy thrombo-embolic or throm botic disease, either under permanent anticoagulation due to residual disease or multiple endoprosthetic treatment, or with endogenous coagu lopathy. In all these women, hysterectomy was either a relative or an absolute contraindication. In 22 patients, treatment resulted in compl ete amenorrhoea or at least hypomenorrhoea (without menometrorrhagia) respectively cyclic spotting. In 6 further patients, amenorrhoea was a chieved after a repeat procedure. Endometrial ablation was thus succes sful in 28 of 34 cases. In these patients, hysterectomy with the risk of major or even lethal complications, could thus be avoided. Hysterec tomy, however, had to be performed in 2 women with extensive adenomyos is uteri interna. Within two respectively three years after endometria l ablation, two other patients died from causes unrelated to the surgi cal intervention (cardiac infarction, cerebral haemorrhage). Follow-up ranged from 1 to 5 years. Hysteroscopic endometrial ablation proved a n effective therapeutic option in this selected group of patients. Oth er indications require further study.