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[Hysteroscopic resection of submucous myomas: long term results]
H Fernandez1, O Kadoch, S Capella-Allouc
1Service de gynécologie-obstétrique, hôpital Antoine-Béclère, 157, rue de la Porte-de-Trivaux, 92141 Clamart, France. herve.fernandez@abc.ap-hop-paris.fr
Study Aim:
To evaluate the follow-up after operative hysteroscopic resection of submucous leiomyomas.
Patients And Methods:
Between January 1990 and December 1996, 200 patients underwent operative hysteroscopic resection of 289 uterine leiomyomas. Indications were: menometrorrhagia (n = 159), postmenopausal metrorrhagia (n = 22), infertility (n = 19) as sole etiology. Sixteen patients had infertility and menometrorrhagia.
Results:
The mean follow-up was 33.4 +/- 19.2 months. Twenty-three patients were lost to follow-up. Due to the large size of the leiomyomas, 35 patients had 2 or 3 resections and a total of 241 hysteroscopic resections were performed. Twelve complications (5%) occurred without death or need for intensive care. An improvement of clinical symptoms was observed in 74% of patients. The predictive factors of failure were: size (> 5 cm), number of intracavitary leiomyomas (> 3), hysterometry (> 12 cm), intramural myoma class 2 and association of leiomyomas. Eight of the 35 infertile patients subsequently became pregnant, but with only two live births (5.8%).
Conclusion:
Hysteroscopic myomectomy appears to be safe, effective and reproducible for the treatment of menstrual disorders. Intramural class 2 and larger leiomyomas constitute the limits of the endoscopic technique.