Total hysteroscopic resection of the endometrium: Critical analysis of indications, techniques and results

130 total hysteroscopic resections of the endometrium (RE) were performed a t the Department of Gynecology and Obstetrics of the Deutschlandsberg Hospi tal from August 1, 1992, to May 31, 1997. 115 patients (88.5%) suffered fro m distinctive therapy-resistant uterine bleeding in terms of hypermenorrhea and menorrhagia, frequently combined with poly- and dysmenorrhea. 15 (11.5 %) women who had previously been operated for breast cancer developed - dur ing continuous treatment with tamoxifen - endometrial hyperplasia or polyps on which RE was performed after a hysteroscopic biopsy or resection had be en carried out in a second setting. The operation showed that 98 out of 115 patients (85.2%) had pathologic anomalous uteri which were the organic cau se of the uterine bleeding. Only 17 women (14.8%) suffered from dysfunction al uterine bleeding (12 cases) or from iatrogenically reduced coagulability (5 cases). The majority of the women (106 cases = 81.5%) were older than 4 0 (average 46.9 +/- 6.21 years). All RE were performed under inhalation ane sthesia whereby the complete uterine cavity up to the inner orifice of the uterus was resected with the resectoscope loop. 92 out of 130 patients (70. 8%) underwent a hysteroscopy or a dilatation and curettage before the RE. 7 7 patients (66.9%) received pretreatment with drugs to reduce the endometri um. 15 women (13.0%) underwent a laparoscopic tubal sterilization in the sa me setting. Finally, the results of 107 patients were analyzed excluding dr opouts and patients who had undergone continuous treatment with tamoxifen a nd those who had an observation time of less than 6 months. After an observ ation period of 6-58 months, the success rate was 84.1%. For treatment of r elapses 7 second resections were performed, whereby in I patient with a fur ther uterine bleeding the uterus had to be extirpated. Nine of the 10 remai ning patients had a hysterectomy, 1 patient refused any further treatment. The total hysterectomy rate was 12.2%. Basically, RE is absolutely practica ble as far as the treatment of abnormal uterine bleeding is concerned, sinc e hysterectomy can be avoided in a number of cases. Satisfactory long-term results, however, can only be achieved if indication and operation techniqu e are of high quality. A problem which has not yet been solved is the indic ation and treatment of proliferating adenomyosis uteri interna.