Resumption of menstruation after amenorrhea in women treated by endometrial ablation and myometrial resection

Seeras, R.; Gilliland, G.B.

doi:10.1016/s1074-3804(05)80220-8

Cited by 12 publications

(2 citation statements)

References 8 publications

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“…A similar observation has also been reported by Seeras & Gilliland. 26 The reason for this is not clear. If some endometrium remains after the resection, one would expect it to respond to the hormone stimulation of the ovarian cycle, unless the resection process interferes in some way with the necessary growth factors for such a response.…”

Section: Discussionmentioning

confidence: 99%

Endometrial resection: factors affecting long‐term success

1999

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Objective To identify prognostic factors for the long-term success of transcervical resection of endometrium (TCRE). Design A retrospective analysis. Subjects 301 patients, who chose endometrial resection rather than hysterectomy and who underwent their first TCRE between 17 October 1989 and 31 December 1994.Interventions Endometrial resection carried out by one surgeon (D.W.S.). Main outcome measures Patient satisfaction, degree of bleeding and degree of pain, 1-6 years following TCRE. The procedure was considered to have failed if hysterectomy was necessary later. Results 301 patients underwent a total of 329 procedures (TCRE) and were followed up for 1-6 years (mean 2.8). Complications were few and there was no death or major morbidity. About 80% of patients were satisfied with the procedure and had either amenorrhoea (34%), scanty periods (33%) or moderate/acceptable periods (14%). The incidence of hysterectomy because of the failure of this procedure was 15%. The success rate was significantly higher in the older age group (>40 years); in those without previous moderate or severe dysmenorrhoea; where histological examination of the endometrial chippings did not show any abnormality; where further surgery such as diagnostic hysteroscopy, laparoscopy or repeat resection (repeat TCRE) was not required, and with increasing operator experience. Conclusion TCRE should remain a useful option in the management of women with menorrhagia. Greater awareness of the prognostic factors identified in this study will improve preoperative counselling and the appropriate selection of patients for TCRE.

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Section: Discussionmentioning

confidence: 99%

Endometrial resection: factors affecting long‐term success

1999

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“…There is also histologic evidence of endometrial gland survival regardless of power settings after endometrial ablation [8] and of both focal and diffuse endometrial regeneration over time following complete endometrial destruction [9][10][11][12]. These findings may explain cyclical pain in amenorrhoeic women and the resumption of menstruation following a bleed-free interval.…”

Section: Introductionmentioning

confidence: 99%

Variable pressure cornual resection. Does radical hysteroscopic surgery give better results?

et al. 2006

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The radicality of the resective technique at transcervical endometrial resection (TCRE) may affect both the safety and efficacy. We evaluated both a more and a less extreme technique and compared results with our standard TCRE. A nonrandomised, prospective cohort study of three standardised endometrial resection/ablation techniques, each with differing tissue destruction profiles, was performed on 270 patients. Percentage reduction in bleeding, satisfaction, complications, and failures were recorded. Group 1 had standard loop resection circumferentially from the fundus to the internal os with current blend 1, power 120/60 W. The method for group 2 was the same as for group 1, with additional radical cornual resection followed by rollerball ablation to the entire cavity and cervical canal using the same power settings. To establish the safety of the cornual resection component, 25 cases were performed under laparoscopic control. In the first 15 cases, the extra cornual material excised was weighed separately and its contribution to the total weight calculated. Group 3 had slow low-power rollerball ablation to the cavity, cornua, and cervical canal with unmodulated power at 30 W. There were 68, 131, and 71 patients in the respective groups, followed up for a maximum of 36 months, with amenorrhoea rates of 31%, 36%, and 31%. Failure (a need for a further procedure) occurred in 18%, 12%, and 20%, respectively, and the preoperative to postoperative percentage reduction in bleeding between groups 2 and 3 was 78% (standard deviation 26) and 79% (standard deviation 33). There were no statistical differences in clinical outcome measures, complications, or satisfaction rates. The extra cornual endometrium comprised a mean additional 9%. This study did not support the premise that more radical techniques confer advantage in clinical outcome, although a trend towards a lower failure rate with the radical resection method may achieve significance with greater numbers. Principally, the greater failure rate in the rollerball group was due to cyclical pain despite improvement in bleeding score. Where satisfaction and safety is consistently high, the most straightforward procedure of rollerball ablation may be preferable, but the possible higher failure rate with this technique will require further qualification.

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