Transcervical endometrial resection in 197 women. Hysterectomy rate and associated risk factors after a 5–8‐year follow‐up period

Abstract

ABSTRACTObjective To identify the hysterectomy rate and associated factors following transcervical resection of the endometrium (TCRE).Design Prospective observational study over an 8‐year period.Setting Endoscopic Unit and Medical Audit Department, Derriford Hospital, Plymouth, UK.Sample The first 197 women to undergo TCRE for menstrual disorders under the care of the senior author (J.M.F.).Interventions Hysteroscopic endometrial resection and rollerball ablation.Main outcome measure Hysterectomy rate.Results All women were followed up from a minimum of 5 to a maximum of 8 years. The mean age was 41 years (range 24–56). The procedure was abandoned in three cases. There were no deaths. Immediate complications occurred in 5% of patients (including five uterine perforations and one case of deep venous thrombosis). No serious fluid overload sequelae occurred. There was one case of atypical endometrial hyperplasia, but no cancer was found. At the end of the study (median follow up of 72 months), survival analysis showed that the hysterectomy rate because of persistent menstrual complaints was 25%. Five hysterectomies were done because of uterine perforation at the time of TCRE and four for unrelated reasons. Multivariate analysis identified only blood loss at TCRE as an independent risk factor for hysterectomy. Other operative variables (age, surgeon, size of uterus, presence of fibroids, volume of glycine used, operating time, synchronous laparoscopic sterilization, and repeat TCRE) had no effect on the hysterectomy risk.Conclusions Our results indicate that women who are offered a TCRE should be warned that they have a one‐in‐four risk of subsequently having a hysterectomy for persistent menstrual complaints. However, TCRE is a quick, safe operation with minimal operative morbidity. A repeat TCRE and the presence of fibroids did not increase the risk of hysterectomy in this group of women.