A NATIONAL SURVEY OF THE COMPLICATIONS OF ENDOMETRIAL DESTRUCTION FORMENSTRUAL DISORDERS - THE MISTLETOE STUDY

Objectives To study the frequency of complications of endometrial rese ction and ablation for menstrual disturbances and the influence of the experience of the operators. Design Prospective survey with additiona l retrospective reporting by theatre staff. Setting 300 National Healt h Service and independent hospitals in the United Kingdom (excluding S cotland). Population 10,686 women registered by 690 doctors (1-222 cas es/doctor) from April 1993 to October 1994. Methods Mailings were sent to relevant medical and non medical staff at every hospital to ascert ain who performed the operations. These doctors were asked to complete a questionnaire detailing their previous experience. Completed patien t registration forms were returned each month. Theatre contacts return ed lists of cases reported in theatre registers. Main outcome measures Perioperative, post-operative and delayed complications by method of surgery and experience of operator. Results Two directly related death s were reported. Laser and rollerball ablations were associated with l east operative and post-operative complications. Combined loop and rol lerball diathermy was associated with a higher rate, but with fewer im mediate operative complications than loop resection alone. Endometrial thinning agents were not associated with decreased complications. Fib roids were associated with increased operative haemorrhage. Early post -operative complication rates ranged from 0.77% to 1.51%. Six-week fol low up in 82.5% of tile women revealed few complications (1.25% to 4.5 8%). Increasing operative experience was associated with fewer uterine perforations in the loop resection alone group (chi(2) for trend, P < 0.001), but had no effect on operative haemorrhage in any group. Conc lusions These procedures were used widely in 1993 to 1994 with low mor bidity and mortality. The techniques may be relatively easily learned in the apprenticeship system without compromising safety. Combined dia thermy resection appears safer than loop resection alone, but laser an d rollerball ablation were safest.