Is balloon ablation as effective as endometrial electroresection in the treatment of menorrhagia?

Background: Hot-fluid balloon therapy is a recently introduced, relatively simple endometrial ablation procedure for menorrhagia. Because it is though t to be safer than other ablation procedures, it would be superior to other types of ablation if it is equally effective. The purpose of the present s tudy was therefore to compare the safety and effectiveness of balloon ablat ion and transcervical resection of the endometrium (TCRE) for the treatment of menorrhagia. Patients and Methods: We performed a prospective cohort study comparing TCR E and hot-fluid balloon ablation in consecutive patients suffering from men orraghia and not responding to medical treatment. Between 1992 and 1994, al l patients had TCRE, whereas from 1995 onward, all patients had balloon the rapy. Outcome measures were surgical reintervention, menstrual pattern, and patient satisfaction. Assuming a 9% reintervention rate after TCRE, a seri es of 150 patients was required to show balloon ablation to be equally effe ctive. Results: Of the 152 patients who were included, 75 underwent TCRE and 77 ha d balloon ablation. The procedure had to be abandoned in 13 patients in the TCRE group (17%) and in 8 patients in the balloon ablation group (10%). In the TCRE group, four patients underwent a second resection, whereas hyster ectomy was performed in 15 patients (3-year cumulative reintervention rate 26%). In the balloon-ablation group, there were no reresections, whereas hy sterectomy was performed in 9 patients (3-year cumulative reintervention ra te 13%) (log-rank test P = 0.11). The relative risk for any reintervention was 0.36 (95% confidence interval 0.05-2.5). At 3 months' followup the dura tion of menstruation was significantly shorter after TCRE than after balloo n ablation, but at 6, 12, and 24 months, the duration of menstruation in th e two groups appeared to be equal. No difference in patient satisfaction co uld be detected between the two groups, but there appeared to be a statisti cally significant decline in patient satisfaction over time for both therap ies. This decline was stronger after TCRE than after balloon ablation. Conclusions: Because endometrial ablation with a hot-fluid balloon seems to be as effective as endometrial resection, with a lower complication rate, balloon ablation might become the procedure of choice for endometrial ablat ion.