Hysteroscopic resection of submucous myoma: a result of 50 procedures at Ramathibodi Hospital.

ABSTRACT

We reported an initial result of the safety and efficacy of myomectomies performed between September 1994 and June 1997 by the hysteroscopic resectoscope in 50 patients at Ramathibodi Hospital. The indications for hysteroscopy and/or hysteroscopic myomectomy were menorrhagia in 23, metrorrhagia in 3, menometrorrhagia in 2, infertility with abnormal uterine bleeding in 12, abnormal uterine bleeding during hormonal replacement therapy (HRT) in 4, and suspected submucous myomas detected by ultrasonography and/or sonohysterography in 6 patients. The mean age of the 50 patients was 39.5 years with a range of 26 to 66 years. The sizes of the submucous myomas ranged from 1-5 cm. The mean of operation time was 32 minutes (range 15-60 minutes). The mean volume of 1.5 per cent glycine required for irrigation was 800 with a range of 600-2000 ml, and the mean deficit at the end of the operation was 300 with a range of 200-1000 ml. The mean estimation of blood loss during the operation was 80 ml with a range of 50-200 ml. Postoperatively 28 out of 30 patients with menorrhagia had improvement in excessive bleeding (93.33%). One patient underwent subsequent hysterectomy due to persistent heavy uterine bleeding from recurrent submucous myoma. All patients with infertility and patients under HRT had normal menstruation after this procedure. 2 out of 12 (16.67%) patients with infertility became pregnant after submucous resection. No serious complications occurred. One patient had a cervical laceration repaired by simple stitches. One patient had mild endometritis responding to outpatient antibiotics. Forty-eight patients were discharged from hospital the day after the operation, the remaining two staying overnight for observing post-operative bleeding. Our data suggested that resectoscopic myomectomy is a safe and effective surgical procedure. The procedure offers the advantage to the patients of a shorter hospital stay along with a low complication rate. The hysteroscopic approach to the symptomatic submucous myoma has dramatically changed the treatment options for patients who classically would be offered abdominal myomectomy or hysterectomy.