Safety and efficacy of hysteroscopic endomyometrial resection-ablation formenorrhagia

OBJECTIVE: To assess the safety and efficacy of endomyometrial resection-ab lation as a surgical means of treating patients with chronic, debilitating menorrhagia. STUDY DESIGN: A retrospective review was carried out of the records of 70 c onsecutive women of reproductive age who had severe uterine bleeding, who d id not wish to retain their reproductive potential and who were managed uni formly at Wyckoff Heights Medical Center from July 1993 to March 1999 by op erative hysteroscopy and endomyometrial resection-ablation under laparoscop ic control. Demographic data were collected, and details of the clinical co urse were assessed for complications of the procedure. The patients were fo llowed for an average of 24 months to evaluate how effective this technique was for correcting the bleeding problem. RESULTS: Immediate postoperative amenorrhea occurred in nearly all cases (9 7.1%). It lasted for only three months in most cases, but persisted for as long as eight months in a small number (5.7%). Some degree of hypomenorrhea was reported for as long as eight months in 88.6%. Overall, almost every w omen reported feeling better (94.3%). Uterine perforation occurred in 8.6%, one case of which was compounded by bladder and ureteral injury. One patie nt experienced fluid overload. Histopathologic examination of the endometri um obtained intraoperatively showed the range of benign conditions that wer e associated with the bleeding problems for which these women had sought ca re. CONCLUSION: Operative hysteroscopy and endomyometrial resection-ablation wa s safe and effective for surgical management of persistent, severe menorrha gia. Patients were largely satisfied with the results. Transient amenorrhea and hypomenorrhea occurred frequently. There was a satisfactory correlatio n between preoperative and postoperative histopathologic findings. No endom etrial malignancy was missed. Fluid overload was almost entirely averted as a significant complication.