Hysterectomy after endometrial ablation
Department of Obstetrics and Gynecology , University of Mississippi, Mississippi, United States American Journal of Obstetrics and Gynecology
(Impact Factor: 4.7).
01/1997; 175(6):1432-6; discussion 1436-7. DOI: 10.1016/S0002-9378(96)70086-8
Our purpose was to determine the number of women undergoing hysterectomy after endometrial ablation and the indications for the subsequent surgery.
Forty-two premenopausal women, who had severe menorrhagia associated with a clinically normal examination result, underwent rollerball endometrial ablation between November 1990 and December 1991. Thirty-seven women whom we gave ongoing care were evaluated by chart review. Four women who received care elsewhere were interviewed by telephone. One woman was lost to follow-up. Patients were followed up a minimum of 4 years. Age, parity, operating time, endometrial preparation, preablation sterilization, and preablation dysmenorrhea were assessed in regard to subsequent hysterectomy. Patient satisfaction was assessed at 24 months. Life-table analysis was performed to determine cumulative probability of hysterectomy.
Fourteen of the 41 women (34%) underwent hysterectomy within 5 years after rollerball endometrial ablation. Continued abnormal menstrual bleeding and menstrual pain were significantly associated with subsequent hysterectomy. Eleven of the 14 cases of hysterectomy were associated with gross abnormality such as myomas, adenomyosis, endometriosis, and chronic hematosalpinx. A linear relationship between hysterectomy and time was noted.
On the basis of our findings one third of women undergoing rollerball endometrial ablation for menorrhagia can expect to have a hysterectomy within 5 years. If the linear relationship noted during the first 5 years is extrapolated, theoretically, all women may need hysterectomy by 13 years. Most patients undergo hysterectomy because of significant pelvic abnormality. Further studies with longterm follow-up are needed to define the role of endometrial ablation for menorrhagia.
Available from: PubMed Central
- "On reviewing the literature on traditional hysteroscopic techniques and the vast number of endometrial ablation reports, especially endometrial resection for the treatment of menorrhagia,7 hysterectomy after endometrial ablation is only indicated in specific cases.8 Follow-up reports over a period of more than 5 years exist. "
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ABSTRACT: Evaluation of long-term results using a thermal balloon endometrial ablation technique to treat menorrhagia and hypermenorrhea, considered dysfunctional uterine bleedings.
A single-arm, prospective study with long-term follow-up of 48 months at the department of obstetrics and gynecology, University of Kiel, Germany. Following hysteroscopic evaluation of the uterine cavity and fractionated curettage, the Cavaterm endometrial thermal ablation technique was performed on 70 patients over the age of 40 with menorrhagia and hypermenorrhea in whom medical treatment had previously failed. The study included a group of 10 patients with adenomyosis and uterine fibroids.
In 65 patients, a complete 48-month follow-up evaluation was possible: 58% of patients reported amenorrhea and 33% hypomenorrhea. Nine percent of patients remained eumenorrheic. Fifty percent of the small group with failed indications for the procedure had to undergo a hysterectomy.
The Cavaterm thermal coagulation system in the earlier mode of application (15 minutes at a temperature of 70 degrees C and a pressure of 200 mm Hg) is a safe and highly effective method of endometrial ablation resulting in a minimal amount of posttreatment menstrual bleeding.
Available from: Arthur M Mccausland
- "He also states that there is increasing evidence that those women who experience failures after endometrial ablation, especially those undergoing hysterectomy, have a high incidence of moderate to severe adenomyosis or intramural leiomyomas. Unger and Meeks (1996) followed 42 patients for a minimum of 4 years following a rollerball endometrial ablation. Fourteen patients underwent hysterectomy within 5 years for recurrent bleeding and/or pain. "
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ABSTRACT: Operative hysteroscopy is a relatively new technique that has significantly improved the diagnosis and therapy of abnormal uterine bleeding. At first, the success of operative hysteroscopy in controlling this bleeding seemed extremely high but, with long-term follow-up, a significant failure rate became evident requiring a repeat hysteroscopic procedure or a hysterectomy. Deep adenomyosis is a major cause of these failures. This paper describes three operative ablation techniques and relates many of their failures to deep adenomyosis. The definition and pathophysiology of adenomyosis are also explored. The possibility of delaying the diagnosis of endometrial cancer under an ablation scar is discussed. Ultimately the depth of adenomyosis seems to correlate with the outcome of endometrial ablation or resection. Patients without or with only minimal endometrial penetration of <2.5 mm (superficial adenomyosis) have good results from the ablation. Patients with deep endometrial penetration of >2.5 mm (deep adenomyosis) usually have persistent problems and should be offered hysterectomy over repeat ablation. Magnetic resonance imaging or ultrasound may be an appropriate pre-operative screening tool to determine the depth of ademomyosis.
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