Ablação histeroscópica do endométrio: resultados após seguimento clínico de 5 anos / Results of hysteroscopic endometrial ablation after five-year follow-up

OBJETIVO: Avaliar os resultados clínicos, após seguimento mínimo de 5 anos, de pacientes com sangramento uterino anormal de etiologia benigna que realizaram ablação endometrial, analisando a taxa de sucesso do tratamento em relação ao método, compreendida como satisfação da paciente e melhora do sangramento uterino anormal, bem como complicações tardias, fatores associados e recorrência dos sintomas. MÉTODOS: Estudo transversal conduzido após período mínimo de 5 anos de cirurgia em pacientes submetidas ao procedimento entre 1999 e 2004. Foram analisados os seguintes dados: faixa etária quando da realização da cirurgia, complicações imediatas e tardias, e fatores associados. Foi utilizado o modelo de regressão logística com cálculo da respectiva Odds Ratio (OR) para se observarem as possíveis associações existentes entre a taxa de sucesso da cirurgia e as variáveis analisadas. RESULTADOS: Cento e quatorze pacientes foram submetidas à ablação endometrial no período de Março de 1999 a Abril de 2004. O tempo mediano de seguimento foi de 82 meses. O modelo de regressão logística permitiu a predição correta do sucesso da ablação endometrial em 80,6 por cento. A idade relacionou-se diretamente com o sucesso do procedimento (OR=1,2; p=0,003) e a ligadura tubária pregressa mostrou relação inversa com o sucesso da ablação endometrial (OR=0,3; p=0,049). Dentre as pacientes com falha terapêutica, 21 (72,4 por cento) foram tratadas com histerectomia. Em uma das pacientes submetidas à histerectomia foi confirmada a presença de hidro-hematossalpinge ao exame anatomopatológico, caracterizando a síndrome da ligadura tubária pós-ablação. CONCLUSÃO: A ablação endometrial tem se mostrado uma opção de tratamento vantajosa, mantendo altos índices de satisfação das pacientes, mesmo em seguimentos a longo prazo A idade quando da ablação endometrial influenciou no sucesso terapêutico e mais estudos são necessários para avaliar os fatores que poderão futuramente influenciar na indicação do procedimento em casos selecionados.

PURPOSE: To evaluate the clinical outcomes after a minimum period of 5 years of follow-up of patients with abnormal uterine bleeding of benign etiology who underwent endometrial ablation, analyzing the success rate of treatment defined as patient satisfaction and improvement in uterine abnormal bleeding, as well as late complications and factors associated with recurrence of symptoms. METHODS: A cross-sectional survey was conducted after a minimum period of 5 years after surgery in patients who underwent the procedure between 1999 and 2004. We analyzed the following data: age at the time of surgery, immediate and late complications and associated factors. Logistic regression with Odds Ratio (OR) calculation was performed to evaluate possible associations between the success rate of surgery and the analyzed variables. RESULTS: A total of 114 patients underwent endometrial ablation between March 1999 and April 2004. The median follow-up was 82 months. The logistic regression model allowed the correct prediction of the success of endometrial ablation in 80.6 percent of cases. Age was directly related to the success of the procedure (OR=1.2; p=0.003) and previous tubal ligation showed a negative association with the success of endometrial ablation (OR=0.3; p=0.049). Among the patients with treatment failure, 21 (72.4 percent) underwent hysterectomy. In one of the hysterectomy cases, hydro/hematosalpinx was confirmed by the anatomopathological exam, characterizing the postablation-tubal sterilization syndrome. CONCLUSION: Endometrial ablation has proven to be a worthwhile treatment option, maintaining high rates of patient satisfaction, even over long-term follow-up. The age at endometrial ablation influenced the therapeutic success. Further studies are needed to evaluate the factors that may influence the future indication for the procedure in selected cases.

Thermal balloon endometrial ablation as a safe alternative to hysterectomy

To evaluate the safety and efficacy of thermal balloon ablation therapy as an alternative to hysterectomy in the treatment of menorrhagia. A prospective observational study. Urogynaecology unit - Department of Gynaecology and Obstetrics. Ahmad Maher Teaching Hospital. 89 Patients were enrolled in the study. 89 procedures of thermal balloon endometrial ablation were performed from March 2003 till 31 August 2006 using the same protocol. Exclusion criteria includes structural uterine abnormalities, uterine cavity more than 12 cm and premalignant conditions. General anaesthesia was used for all patients. The procedure involves controlled heating of fluid in an intrauterine specifically designed balloon for thermal ablation of the uterine cavity. No intra-operative complications occurred, and post-operative complications were minimal. Success rate of the procedure was 93% which means reduction to eumenorrhea or less. Thermal balloon endometrial ablation is a safe as well as effective treatment for menorrhagia and could replace hysterectomy in properly selected women

[Second generation endometrial ablation: surgical treatment of choice for menorrhagia]

Menorrhagia is a very common problem affecting over 20% of women in the reproductive age group. Until 30 years ago hysterectomy was the only surgical treatment available. Although it is 100% effective, it is associated with surgical complications and is more costly both financially and recovery time. The first generation endometrial ablation technique was introduces in the early 1980 as alternative to hysterectomy in suitable cases. This was followed few years later with second generation ablation techniques. These second generation devices avoid the need for hysteroscopic surgery, therefore are quick, easy to perform and can be carried out in out patient setting. Their safety and efficacy is primarily dependent on the devices rather than the operator

Thermal balloon endometrial ablation versus Roller ball ablation in treating premenopausal menorrhagia

To determine whether thermal balloon endometrial ablation can replace Roller ball ablation in treating premenopausal menorrhagia resistant to hormonal therapy. 57 premenopausal women complaining of abnormal uterine bleeding in the form of menorrhagia were enrolled in the study and were divided into 2 groups; group I included 27 women who had thermal balloon endometrial ablation while group II consisted of 30 women who had Roller ball ablation. No medication was used to suppress the endometrium in preparation for ablation in either group. Both procedures were performed under general anesthesia with pre-operative prophylactic antibiotics. All women were followed up for a period 12 months. Both groups were comparable in age, parity and body mass index. The improvement reported in the menstrual pattern after both procedures was not statistically different between both groups [p > 0.05]. Duration of ablation including the time for general anesthesia was significantly higher in group II [p < 0.05]. No significant difference was found in the intra and postoperative complications between the groups except vaginal discharge [p < 0.05]; this was a common postoperative complaint for all women [100%] in group II with a duration lasting between 9-19 days. Only 13 patient [54%] in group I complained of a serosanguious discharge for a period of 5-7 -days. No blood transfusion was required in either group. No fluid overload occurred in any case in group II. Thermal balloon endometrial ablation seems to be safe and effective alternative to Roller ball endometrial ablation in treating premenopausal menorrhagia resistant to hormonal therapy

Randomised Trial of Endometrial Laser Ablation [ELA], Transcervical Resection of the Endometrium [TCRE], and Thermal Balloon Ablation [TBA] for the treatment of menorrhagia

A randomised controlled trial was set up to compare the safety and clinical efficacy of endometrial ablation in the treatment of menorrhagia, performed either with ELA, TCRE or TBA. A total of 120 women with menorrhagia were selected and randomly allocated to ELA [GI], TCRE [GII] or TBA [GIII]. The main outcome measures were operative complications, post-operative recovery, relief of, menstrual and other symptoms, need for further surgical treatment, satisfaction with treatment at 6 and 12 months, postoperatively. It was found that the operating and theatre times were significantly shorter in TBA, than ELA or TCRE. However, there was no significant difference between the three groups as regard the complication rates, concomitant surgery, morbidity and duration of hospital stay. Also, it was found that there was significant improvement in bleeding and pain scores dysmenorrhoea and premenstrual symptoms at 6 and 12 months, in each group. Overall satisfaction levels were high. It was concluded that endometrial ablation is a reliable, safe alternative to hysterectomy for the treatment of monorrhagia. TBA is a safe and effective option. The procedure is simple, allowing the learing curve to be almost negligible