Hysteroscopic endomyometrial resection.

Objective: To determine the efficacy of hysteroscopic endomyometrial resection in treating women with intractable uterine bleeding.

Methods: A retrospective analysis was carried out on 304 women with intractable uterine bleeding treated between August 1, 1991, and December 31, 1997. The average patient was 41.3 +/- 8.0 years old and was followed for a mean of 31.8 +/- 22.1 months (range 6-75 months).

Results: Eighty-three percent of women were amenorrheic at the time of their one-year follow-up. The overall amenorrhea rate was 85.5%. Only 0.8% of subjects reported no improvement during the study period. Histologic analysis of the endomyometrial specimens revealed that 17 (5.6%) women were found to have significant endometrial pathology not previously identified with routine preoperative screening. There was a total of 20 complications (6.6%), although only 2 (0.7%) were considered severe. Twenty-seven women (8.9%) eventually required subsequent surgery during the study period. Finally, 69 (22.7%) women with adenomyosis were identified. They did not appear to be at increased risk for subsequent surgery.

Conclusions: Hysteroscopic endomyometrial resection produces superior results as measured by amenorrhea rates, the need for subsequent surgery and its low incidence of associated complications; and it produces an important histologic specimen. For patients with significant comorbidity, endomyometrial resection can be adapted to a single-stage procedure incorporating the diagnostic and treatment phases in women with abnormal uterine bleeding.