Efficacy of preoperative medical treatment in facilitating hysteroscopic endometrial resection, myomectomy and metroplasty: literature review

The evidence of the efficacy of preoperative medical treatment with danazol , gonadotrophin releasing-hormone agonists (GnRHa) or progestins in facilit ating surgery and improving the long-term results of myomectomy, hysterosco pic metroplasty and endometrial resection has been reviewed. Sixteen random ized and non-randomized controlled clinical trials, published in the Englis h literature between 1990 and 1996, were identified. In all studies compari ng GnRHa or danazol versus no treatment, fluid absorption during surgery wa s less in subjects who underwent medical treatment independently of the dru g used and the type of intervention, the reduction ranging from 142 to 572 mi, A reduction in operating time (between 2 and 25 min) was observed in bo th the danazol and GnRHa-treated groups in comparison with untreated contro ls, regardless of the type of operation (endometrial resection, myomectomy or metroplasty). With regard to long-term results, amenorrhoea tended to be more frequent in patients who received GnRHa: the pooled odds ratio (OR) o f amenorrhoea for GnRHa-treated women compared with untreated controls was 2.0 [95% confidence interval (CI), 1.1-3.8], In studies comparing GnRHa wit h danazol, no marked differences were observed in mean operating time, but the OR of amenorrhoea at 6-12 months after surgery was 1.9 (95% CI 1.0-3.3) .