DOES TRANSCERVICAL RESECTION OF THE ENDOMETRIUM FOR MENORRHAGIA REALLY AVOID HYSTERECTOMY - LIFE TABLE ANALYSIS OF A LARGE SERIES

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.