[Total hysteroscopic endometrium resection: a critical analysis of indications, technique and results]

130 total hysteroscopic resections of the endometrium (RE) were performed at the Department of Gynecology and Obstetrics of the Deutschlandsberg Hospital from August 1, 1992 to May 31, 1997. 115 patients (88.5%) suffered from distinctive therapy-resistant uterine bleeding in terms of hypermenorrhea and menorrhagia, frequently combined with poly- and dysmenorrhea. 15 (11.5%) women who had previously been operated for breast cancer developed--during continuous treatment with tamoxifen--endometrial hyperplasia or polyps on which RE was performed after a hysteroscopic biopsy or resection had been carried out in a second setting. The operation showed that 98 out of 115 patients (85.2%) had pathologic anomalous uteri which were the organic cause of the uterine bleeding. Only 17 women (14.8%) suffered from dysfunctional uterine bleeding (12 cases) or from iatrogenically reduced coagulability (5 cases). The majority of the women (106 cases = 81.5%) were older than 40 (average 46.9 +/- 6.21 years). All RE were performed under inhalation anesthesia whereby the complete uterine cavity up to the inner orifice of the uterus was resected with the resectoscope loop. 92 out of 130 patients (70.8%) underwent a hysteroscopy or a dilatation and curettage before the RE. 77 patients (66.9%) received pretreatment with drugs to reduce the endometrium. 15 women (13.0%) underwent a laparoscopic tubal sterilization in the same setting. Finally, the results of 107 patients were analyzed excluding dropouts and patients who had undergone continuous treatment with tamoxifen and those who had an observation time of less than 6 months. After an observation period of 6-58 months, the success rate was 84.1%. For treatment of relapses 7 second resections were performed, whereby in 1 patient with a further uterine bleeding the uterus had to be extirpated. Nine of the 10 remaining patients had a hysterectomy, 1 patient refused any further treatment. The total hysterectomy rate was 12.2%. Basically, RE is absolutely practicable as far as the treatment of abnormal uterine bleeding is concerned, since hysterectomy can be avoided in a number of cases. Satisfactory long-term results, however, can only be achieved if indication and operation technique are of high quality. A problem which has not yet been solved is the indication and treatment of proliferating adenomyosis uteri interna.