As. Pooley et al., DOES TRANSCERVICAL RESECTION OF THE ENDOMETRIUM FOR MENORRHAGIA REALLY AVOID HYSTERECTOMY - LIFE TABLE ANALYSIS OF A LARGE SERIES, The Journal of the American Association of Gynecologic Laparoscopists, 5(3), 1998, pp. 229-235
Study Objective. To determine long-term success and complication rates
of transcervical resection of endometrium (TCRE) for menorrhagia. Des
ign. Retrospective audit of a continuous case series with a minimum of
2 and a maximum of 5 years' followup (Canadian Task Force classificat
ion II-2). Setting. District general hospital and tertiary referral ce
nter for gynecologic endoscopy. Patients. Three hundred eighty consecu
tive women with menorrhagia. Intervention. TCRE performed as a day cas
e or with overnight stay between August 1988 and December 1992. Measur
ements and Main Results. Complications occurred in 6.8% of patients, w
ith a perforation rate of 3.2%. Life table analysis showed a cumulativ
e hysterectomy rate of 12.4% at 1 year, reaching a plateau of 27.4% af
ter 4 years. The rate at 5 years was higher for women under age 45 yea
rs (35%) than for those 45 and over (14.9%, p <0.01, Mantel's test x(2
)). Women whose operation was performed by a senior surgeon had a lowe
r cumulative hysterectomy rate (12.6%) than those whose surgery was pe
rformed at least in part by trainees (38%, p <0.01, Mantel's text x(2)
). There was no significant difference in cumulative hysterectomy rate
s between women who had uterine fibroids and those who did not. Ninety
-six percent of hysterectomies were performed in the first 3 years aft
er initial TCRE. Conclusion. Although TCRE for menorrhagia did not avo
id hysterectomy in all women, for those considering hysterectomy, it w
as a conservative procedure with low morbidity and high chance of avoi
ding the need for major surgery, especially when performed in women ov
er age 45, by an experienced surgeon.