Transcervical electrosurgical resection of submucous leiomyomas for chronic menorrhagia

To evaluate the effectiveness and safety of transcervical electrosurgical resection (TSR) of submucous leiomyomas with or without concomitant transcervical endomyometrial resection (TEMR) for chronic menorrhagia.

Prospective observational study, with 6-month follow-up of all 208 women and up to 6-year follow-up of 185 (88.9%).

Gynecology departments of teaching, community, and proprietary hospitals.

Two hundred eight women with submucous leiomyoma requiring surgical treatment of menorrhagia between March 1988 and March 1994.

All 208 women (age range 32-63 yrs) underwent TSR with a continuous-flow gynecologic resectoscope. In 88 of these women who had no desire to preserve fertility, concomitant TEMR was performed.

Six months postoperatively 113 (94.2%) of the 120 women who underwent only TSR reported normal menses and 85 (96.6%) had satisfactory results; 62 (70.5%) who had both TSR and TEMR were amenorrheic. Eleven (73%) of the 15 women who had TSR and wanted to conceive subsequently became pregnant. One hundred eighty-five (88.9%) of the 208 patients have been followed for as long as 6 years. Ninety (84.1%) of the 107 women who had only the initial TSR and 69 (88.5%) of the 78 who had initial TSR and TEMR had satisfactory results. Only five women (2.7%) required major abdominal surgery. Among those undergoing TSR and TEMR, 49 (62.8%) were amenorrheic for as long as 6 years after TSR and one or two TEMRs. Eight (3.8%) of the 208 women had perioperative complications: 6 (2.9%) had fluid overload, 1 (0.5%) had dilutional hyponatremia, and 1 (0.5%) had excessive postoperative bleeding requiring tamponade.

We believe that TSR with or without concomitant TEMR is an effective and safe treatment for women with submucous leiomyomas suffering from chronic menorrhagia.