Regression of residual tissue after incomplete resection of submucous myomas

Objective Assessment of regression of residual tissue after incomplete tran scervical resection of myomas (TCRM), by transvaginal ultrasound examinatio n with the use of saline infusion into the cavity (hysterosonographic exami nation; HSE). Settings A university teaching department. Subjects 45 patients with menometrorrhagia. Interventions The patients were followed up with HSE for 6 months after TCR M. The mean diameter of the myomas as assessed by preoperative HSE was 3.2 cm (range 1.5-5). According to the European Society of Gynaeological Endosc opy (ESGE) standards the myomas were classified as 11 type II, 28 type I an d 6 type 0 myomas. TCRM was performed until the incision was level dth the myometrium. Resection was complete in seven patients, who mainly had pedunc ulated tumours. Results At 2 weeks after the operation 33 of the 38 patients who had underg one incomplete resection still had residual tissue demonstrated at HSE, and all the patients had endometrial defects. During the following 2 months, r e-resection was performed in three patients because of persistent heavy ble eding. At 3 months after the operation, total regression of residual tissue tvas found in a further 16 patients. Thus, at 3 months, out of 35 of the p atients with an initially incomplete resection, 21 patients showed spontane ous regression. Re-resection was subsequently performed in four patients an d hysterectomy in one patient. During observation for a further 3 months or more, total regression was Seen in one patient. Accordingly spontaneous re gression was observed in a total of 22 of 35 patients with an incomplete pr imary resection. Conclusions The results indicate that spontaneous regression of residual ti ssue left behind after incomplete resection of partially intramural submuco us myomas is seen in more than half of patients with incomplete primary res ection, mainly during the first 3 months.