[Indications for operative hysteroscopy. A series of 418 interventions]

Over a period of 38 months, from October 1, 1987 to December 31, 1990, 418 surgical hysteroscopies were carried out following systematic pre-operative hysteroscopy. Two-hundred and eighty-two patients presenting with a benign intercavitary lesion were treated by transcervical endo-uterine resection (EUR). The efficacy of the surgical method was assessed from the control of hemorrhagic phenomena, the most frequent sign. 89.7 percent of the patients who presented with menometrorrhagia, had become asymptomatic from the first cycle after EUR and 83.5 percent remained asymptomatic after a mean follow-up period of 28 months, 71 endometrectomies were carried out by EUR during this period, after careful hysteroscopic and histological evaluation of the endometrium. The results after one year of cycles were satisfactory in 82 percent of patients. Twenty-two patients presenting with a uterine septum were treated by endoscopic hysteroplasty. In most cases, the authors used the tip of the Charriere 21 resector. The follow-up period exceeds 1 year in 15 patients, 11 of whom became pregnant, giving birth to 9 live infants, 43 cases of synechia were treated by hysteroscopy in the context of Ashermann's syndrome. The functional results were good in 90 percent of patients, with the restoration of normal cycles. Only limited results were obtained in fertility in cases of muscular or fibrous synechia. The risks linked to surgical hysteroscopy are analysed. They appear to be acceptable, on condition that rigorous methods are used. The quality of sequelae and the short hospitalization make operative hysteroscopy preferable in the selected indications.