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Risk of uterine perforation during hysteroscopic surgery
Aubert Agostini1, Ludovic Cravello, Florence Bretelle
1Service de Gynécologie-Obstétrique B, Hôpital de la Conception, 147 Boulevard Baille, 13385 Marseille Cedex 05, France.
Study Objective:
To evaluate the rate of uterine perforation during different operative hysteroscopy procedures.
Design:
Observational study (Canadian Task Force classification II-2).
Setting:
Department of Obstetrics and Gynecology, La Conception Hospital, Marseille, France.
Patients:
One thousand nine hundred fifty-two women.
Intervention:
Of 2116 operative hysteroscopies performed, there were 623 endometrectomies, 782 myoma resections, 422 polyp resections, 199 adhesiolyses, and 90 uterine septa sections.
Measurements And Main Results:
Risk of perforation was evaluated according to hysteroscopic procedure. Severity of complications were also noted. In case of perforation, a management protocol was applied to prevent metabolic disorders and pelvic infections. Thirty-four perforations (1.61%) were reported. In 33 cases (97%) it was realized during the procedure and no complications occurred during follow-up. One perforation with hemorrhage was misdiagnosed during the intervention and required laparotomy. Perforation risk was higher during hysteroscopic adhesiolysis than during other procedures [endometrial ablation RR 9.39 (3.46-25.52), p <0.0001; uterine septa section RR 6.78 (0.91-50.6), p = 0.026; polyp RR 8.52 (2.60-30.80), p <0.0001 or myoma resection RR 7 (2.83-17.62), p <0.0001]. Perforation risk was comparable during endometrial ablation, uterine septa section, and polyp or myoma resection (p = 0.93).
Conclusion:
Perforation risk is higher during synechiolysis than in other indications for hysteroscopy. Severe complications are rare but may be avoided if precautions are taken.