General Obstetrics and Gynecology: Gynecology
Hysteroscopic transcervical endometrial resection versus thermal destruction for menorrhagia: A prospective randomized trial on satisfaction rate☆

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Abstract

Objective: The purpose of this study was to compare the satisfaction rate and the effectiveness of transcervical hysteroscopic endometrial resection and thermal destruction of the endometrium in the treatment of menorrhagia. Study Design: A prospective randomized trial with 2 years of follow-up was carried out in the Department of Gynecology of the University of Naples. Eighty-two patients who were affected by menorrhagia that was unresponsive to medical treatment were respectively randomized to transcervical hysteroscopic endometrial resection or to thermal destruction of the endometrium. Satisfaction rate, operative time, discharge time, complication rate, reintervention rate, and resumption of normal activity were evaluated in each group. Results: The satisfaction rate was significantly higher in the thermal destruction group. Operative time was significantly shorter in the thermal destruction group (24 ± 4 minutes vs 37 ± 6 minutes). Intraoperative blood loss was significantly lower in the thermal destruction group (7.2 ± 2.8 mL vs 89 ± 38 mL). Reintervention rates were higher in the transcervical hysteroscopic endometrial resection group, although postoperative pain was not significantly different between the two groups. Discharge time, complication rate, and resumption of normal activity were not significantly different between the two groups. Conclusion: Thermal destruction of the endometrium for the treatment of menorrhagia should be considered an effective therapeutic option because of its acceptability among patients, shorter operative time, and lower blood loss. (Am J Obstet Gynecol 2002;187:545-50.)

Section snippets

Material and methods

The study design was approved by the Ethics Committee of Federico II University of Naples. All patients who were referred to the Department of Obstetrics and Gynecology of University of Naples because of menorrhagia and who were unresponsive to medical treatment were invited to participate in the study.

Inclusion criteria were women aged below 50 years who weighed <100 kg not desiring pregnancy; a documented history of at least 3 months of failed medical therapy; documented evidence of normal

Results

One hundred five patients gave written consent to the trial, but only 82 patients entered into the study, of whom 42 women were treated by HTER and 40 women were treated by TD. Overall, 33 patients from the HTER group and 35 patients from the TD group completed the trial.

There were no differences in terms of age, parity, body mass index, uterine dimensions, preoperative hemoglobin, symptom patterns, and duration of symptoms between the 2 groups (Table I).

. Characteristics of the patients who were

Comment

This trial was designed to evaluate the advantages and the disadvantages of HTER, when compared with the least invasive type of TD. In this regard, we considered the main outcome measure to be the satisfaction rate of the patients. Most patients who undergo ablation consider satisfaction to be the subjective reduction of bleeding symptoms.17, 18, 19, 20, 21, 22 Five previous randomized controlled trials3, 4, 5, 6, 7 that compared traditional hysterectomy (abdominal and/or vaginal) and HTER

Acknowledgements

Surgical equipment for this investigation was provided by Wolf, Germany and Wallsten Medical SA, Morges, Switzerland.

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    ☆

    Reprint requests: Massimiliano Pellicano, MD, Department of Obstetrics, Gynecology, and Reproductive Medicine, University of Naples, Via Pansini 5, 80131, Naples, Italy (I). E-mail: [email protected]

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