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Published on: January 22, 2022
Does transcervical resection of the endometrium for menorrhagia really avoid hysterectomy? Life table analysis of a
A S Pooley1, S P Ewen, C J Sutton
1Department of Gynecology, St. George's Hospital, Blackshaw Road, Tooting, London SW17, United Kingdom.
Study Objective:
To determine long-term success and complication rates of transcervical resection of endometrium (TCRE) for menorrhagia.
Design:
Retrospective audit of a continuous case series with a minimum of 2 and a maximum of 5 years' follow-up (Canadian Task Force classification II-2).
Setting:
District general hospital and tertiary referral center for gynecologic endoscopy.
Patients:
Three hundred eighty consecutive women with menorrhagia.
Intervention:
TCRE performed as a day case or with overnight stay between August 1988 and December 1992.
Measurements And Main Results:
Complications occurred in 6.8% of patients, with a perforation rate of 3.2%. Life table analysis showed a cumulative hysterectomy rate of 12.4% at 1 year, reaching a plateau of 27.4% after 4 years. The rate at 5 years was higher for women under age 45 years (35%) than for those 45 and over (14.9%, p <0.01, Mantel's test x(2)). Women whose operation was performed by a senior surgeon had a lower cumulative hysterectomy rate (12.6%) than those whose surgery was performed at least in part by trainees (38%, p <0.01, Mantel's text x(2)). There was no significant difference in cumulative hysterectomy rates between women who had uterine fibroids and those who did not. Ninety-six percent of hysterectomies were performed in the first 3 years after initial TCRE.
Conclusion:
Although TCRE for menorrhagia did not avoid hysterectomy in all women, for those considering hysterectomy, it was a conservative procedure with low morbidity and high chance of avoiding the need for major surgery, especially when performed in women over age 45, by an experienced surgeon.
