2887 Hysterectomy after Failed Endometrial Resection and Endometrial Ablation Techniques. Can We Work Out When It is Going to Fail?

Abstract

Study Objective Heavy Menstrual Bleeding is the most common reason for gynaecological consultation in the United Kingdom. We aimed to identify factors that may contribute to failed ablation/resection of endometrium, to improve future patient selection and counselling. Design Retrospective audit was performed for women who underwent hysterectomy, January 2012 - December 2018, following a Thermablate, NovaSure, or transcervical resection of endometrium (TCRE). Setting Northern Health and Social Care Trust, Northern Ireland. Patients or Participants 85 patients were identified by clinical coding department. Interventions N/A. Measurements and Main Results Mean age at hysterectomy was 43 years, Average body mass index (BMI) was 31.73 kg/m2. 87% underwent a pre-operative pelvic ultrasound scan, of these 32% had fibroids detected. 72% underwent endometrial ablation using Thermablate, 17% NovaSure, 2% Thermablate followed by NovaSure, 2% had Thermablate twice, performed nine months apart, and 7% patients had transcervical resection of the endometrium. 47% had a trial of Mirena IUS prior to ablation. Mean ablation to hysterectomy interval was 23 months. The main indication for hysterectomy was heavy menstrual bleeding (75%), followed by pelvic pain (13%), then both heavy menstrual bleeding and pelvic pain (11%). Mean specimen weight at hysterectomy was 183g. Abnormal pathology was confirmed in 70% of hysterectomy specimens (Fibroids 54%, adenomyosis 14% and combined pathology including fibroids, adenomyosis, simple hyperplasia and endometriosis in 32%. Dysmenorrhoea, parity, previous normal vaginal deliveries/caesarean section, BMI and type of ablation did not reach clinical significance in terms of predictive parameters. Conclusion When ablation/ resection fails our results demonstrated that the pre-operative demographics above were a poor predictor. Associated identified pathologies particularly fibroids and adenomyosis suggests that pre-operative diagnosis of these would be valuable in optimizing patient selection and counselling.