Does transcervical resection of the endometrium for menorrhagia really avoid hysterectomy? Life table analysis of a large series.
OBJECTIVE
To determine long-term success and complication rates of transcervical resection of endometrium (TCRE) for menorrhagia.


METHODS
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).


METHODS
District general hospital and tertiary referral center for gynecologic endoscopy.


METHODS
Three hundred eighty consecutive women with menorrhagia.


METHODS
TCRE performed as a day case or with overnight stay between August 1988 and December 1992.


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.


CONCLUSIONS
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.
Department of Gynecology, St. George's Hospital, Blackshaw Road, Tooting, London SW17, United Kingdom.
A S
AS
Pooley
S P
SP
Ewen
C J
CJ
Sutton
D000328:Adult; D004717:Endometrium / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D015993:Life Tables; D008595:Menorrhagia / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome