Retrospective analysis of 305 consecutive cases of endometrial ablation and partial endomyometrial resection.

STUDY OBJECTIVE: To assess the efficacy and safety of operative resectoscopy, partial endomyometrial resection, and endometrial ablation in the evaluation and treatment of abnormal uterine bleeding. DESIGN: Retrospective analysis of 305 consecutive cases of endometrial ablation and partial endomyometrial resection. SETTING: Midwestern urban obstetric and gynecology group practice and teaching hospitals. PATIENTS: Three hundred five women (age 30-72 yrs) with abnormal uterine bleeding. Interventions. Partial endomyometrial resection and endometrial ablation. MEASUREMENTS AND MAIN RESULTS: Of the 301 patients who completed surgery and follow-up, 283 (97%) reported improvements in amenorrhea (55%), hypomenorrhea (41%), and eumenorrhea (1%). Ten (3%) failed to report improvement. In 24 (7.9%) women, hysterectomy was performed for various reasons after endometrial ablation, including recurrent bleeding in 4. Four uterine perforations occurred, infection was suspected in one patient, and loss of Laminaria occurred in another; all patients, however, were observed appropriately and discharged the same day of surgery. CONCLUSIONS: Partial endomyometrial resection and endometrial ablation is a safe and effective treatment of abnormal uterine bleeding, and may be an alternative to hysterectomy in selected patients.

Postablation-tubal sterilization syndrome.

Operative resectoscopy and endometrial ablation are often performed to treat abnormal uterine bleeding, but little is known about the potential late complications of these procedures. We reviewed the records of 305 women who underwent endometrial ablation at a midwestern obstetrics and gynecology group practice and teaching hospital between July 1990 and October 1995. For 71 women, tubal ligation, salpingectomy, or tubal sterilization was performed at the time of ablation. Of these, six (8.4%) developed intense cyclic pain 5 to 40 months after surgery. Four subsequently underwent exploratory laparotomy and hysterectomy, and two others underwent laparoscopic tubal resection and destruction. Gross pathologic findings revealed hematosalpinx, and microscopic examination showed endometriosis, acute and chronic inflammation of the fallopian tubes, and acute and chronic myometritis. We believe these characteristic clinical and pathologic findings are consistent with postablation-tubal sterilization syndrome, a distinct clinical entity arising as a late complication of endometrial ablation in patients with a history of tubal ligations and/or obstruction.