[Endometrial resection for metrorrhagia: 45 cases]

Treatment of metrorrhagia has recently been modified because of the use of the hysteroscope which allows two methods to be used: diathermy and endometrial ablation or laser destruction of the endometrium. This retrospective study of ablation of the endometrium was carried out on 45 cases: the patients had excessive bleeding or menorrhagia that had been developing and in an average about 18 months. The mean age of the patients was 48 years with a deviation of 7 years. More than half the women were overweight, a quarter weighing more than 80 kgs with a height of 1 metre 60. A third of the cases had pathology associated with the condition. In 24 cases endometrial resection was carried out by itself but in 21 cases endometrial resection was accompanied with removal of polyps or of submucous myomata. The results were: There was no anaesthetic complication or accident; The operation was complicated only once by perforation of a cornu; Bleeding stopped completely in 94% of cases with an average duration of follow-up of 7 1/2 months; Control hysterosalpingography showed synechiae in 70% of the cases; The histology showed a preponderance of mucosal hyperplasia and of small fibroids. The authors point out: that it is important to learn carefully the operative technique to lessen the risks of complications, but the clinical results compare with the best in the literature but with the price to pay of a high incidence of synechiae. The following questions will have to be answered in the future: What is the risk of cancer after endometrial ablation? Is it possible to avoid synechiae so that the whole cavity of the uterus can be assessed later? What is the role of medical as opposed to surgical treatment in heavy bleeding at the time of the menopause?