Long-Term Results of Endometrial Resection

To evaluate the safety and effectiveness of initial and repeat transcervical resection of the endometrium (TCRE ) in the treatment of menorrhagia, and to estimate the likelihood of treatment failure, we reviewed 525 women treated over 5 years and analyzed our results by life table analysis. Total TCRE was completed in 95.3% of patients, and 112 patients had simultaneous hysteroscopic myomectomy. In 167 women TCRE was performed under local anesthesia. The complication rate was 7.2%. The satisfaction rate varied from 80% to 89.5% over the 5 years. Forty percent of women were amenorrheic at 1 year. Increasing uterine size, young age, fibroids, and lack of endometrial preparation were factors associated with negative outcome. Eighty-six women required further surgery after the initial TCRE, pelvic pain menorrhagia being the most common indications. Eighty percent of patients avoided further surgery and 90% avoided hysterectomy. The failures plateau after 4 years, and even if some women require further gynecologic surgery after this time, it is unlikely that this will have significant impact on the overall results.