Minimally invasive treatment of menorrhagia

ABSTRACT

Eighty women with menorrhagia were recruited in this study. All patients had been treated unsuccessfully with medical therapy. Vaginal ultrasonography and endometrial sampling via endometrial Pipelle, as an outpatient procedure, were carried out to exclude local pathology. Half of the patients have had a preoperative danazole while the other half did not. After proper counselling, transcervical endometrial resection [TRCE] was carried out under general anesthesia. Total resection was done in 72 patients [90%] while 6 patients [7.5%] had partial resection depending on patients wishes. The procedure failed in 2 patients [2.5%] due to perforation, both of whom were needed laparotomy and hysterectomy. The average fluid balance was 560 ml and operating time was 54.2 minutes. Excessive intraoperative bleeding requiring tamponade with a Foley's catheter for 6 hours occurred in 2 patients [2.5%]. The average postoperative hospital stay was 0.8 day. The average duration of postoperative bleeding and discharge were 10.7 and 10.1 days, respectively. Follow-up results at 6 months showed that total resection has resulted in amenorrhea in 63.9%, overall menstrual improvement in 27.8% and no improvement in 8.3% of patients. Partial resection has resulted in amenorrhea in 33.3% and overall menstrual improvement in 66.7% of patients. In conclusion, TRCE is an advance in the management of menorrhagia. The technique produces a very high rate of amenorrhea with a low complication rate but adequate training is required. Postoperative morbidity, length of hospital stay, time taken for return to work and normal daily activities are obvious advantages of TRCE over hysterectomy