A randomised trial comparing endometrial resection and abdominal hysterectomy for the treatment of menorrhagia.

Abstract

It is difficult to offer an alternative to an infective explanation for the present findings. A possible relation between leukaemia in children under 1 year and maternal use of drugs such as marijuana'7 cannot be relevant here, since the period in question long preceded any appreciable use of such drugs in Britain. Similarly, a hypothesis about mutations caused by delayed exposure to immunological challenges'8 cannot be invoked since it would apply only in leukaemia occurring later than the ages that show the excess in this study.The findings support the hypothesis that prompted this study-that the presence of large numbers of servicemen, particularly in rural districts, was conducive to an increase in the incidence of childhood leukaemia. They also point to an infection transmitted among adults, as also implied by a recent study of the effects of the population mixing associated with increases in commuting. ' Design-Randomised study of two treatment groups with a minimum follow up of nine months.Setting-Royal Berkshire Hospital, Reading. Subjects-51 of 78 menorrhagic women without pelvic pathology who were on the waiting list for abdominal hysterectomy.Treatment-Endometrial resection or abdominal hysterectomy (according to randomisation). Endometrial resections were performed by an experienced hysteroscopic surgeon; hysterectomies were performed by two other gynaecological surgeons.Main outcome measures-Length of operating time, hospitalisation, recovery; cost of surgery; short term results of endometrial resection.Results-Operating time was shorter for endometrial resection (median 30 (range 20-47) minutes) than for hysterectomy (50 (39-74) minutes). The hospital stay for endometrial resection (median 1 (range 1-3) days) was less than for hysterectomy (7 (5-12) days). Recovery after endometrial resection (median 16 (range 5-62) days) was shorter than after hysterectomy (58 (11-125) days). The cost was £407 for endometrial resection and £1270 for abdominal hysterectomy. Four women (16%) who did not have an acceptable improvement in symptoms after endometrial resection had repeat resections. No woman has required hysterectomy during a mean follow up of one year.Conclusion-For women with menorrhagia who have no pelvic pathology endometrial resection is a useful alternative to abdominal hysterectomy, with many short term benefits. Larger numbers and a longer follow up are needed to estimate the incidence of complications and the long term efficacy of endometrial resection. IntroductionEndometrial resection is gaining widespread acceptance as a surgical treatment for menorrhagia. A survey in August 1990 showed that 36 British centres had performed a total of over 4000 endometrial ablation procedures.' Seventy per cent of these were endometrial resections with the urological resectoscope.The technique was initially used for treating intractable uterine bleeding in women who were unfit for hysterectomy because of blood dyscrasias or extreme anaesthetic risk.2 Follow up showed that most remained amenorrhoeic. Tr...

Hysterectomy, endometrial ablation and Mirena® for heavy menstrual bleeding: a systematic review of clinical effectiveness and cost-effectiveness analysis

“…Overall, we received some IPD from 65% (2814/4305) of women involved in the trials, although only eight studies were able to provide all requested variables. 41,42,53,94,95,99,102,109 The remaining studies had some missing information, with limited details on patient follow-up covering subsequent operations (e.g. hysterectomy following Mirena).…”

“…Six of these studies involved first-generation techniques. [41][42][43][44][45]78 The seventh study used a combination of first and second generation in equal proportions 92 and was included here as a first-generation comparison, with a sensitivity analysis performed without the trial. One study compared hysterectomy 93 with Mirena.…”

“…Although none guarantees amenorrhoea, their effectiveness (in comparison with hysterectomy) has been demonstrated in a number of RCTs. [41][42][43][44][45][46] National audits 47,48 revealed that, although first-generation ablative techniques were less morbid than hysterectomy, they were associated with a number of complications, including uterine perforation, cervical laceration, false passage creation, haemorrhage, sepsis and bowel injury. In addition, fluid overload associated with the use of 1.5% urological glycine (non-ionic) irrigation fluid in TCRE and RBEA resulted in serious and occasionally fatal consequences due to hyponatraemia.…”

Psychiatric morbidity following endometrial ablation and its association with genuine menorrhagia

“…It is a relatively safe operation with low levels of morbidity and mortality 42 . Complications are significantly fewer than hysterectomy when compared in randomised controlled trials 23,24,38,41,43 . Satisfaction ratings are broadly similar 38,43 or in favour of hysterectomy 23,44 probably as a result of continued bleeding and dysmenorrhoea in some women after endometrial ablation.…”

“…Women prefer it because it avoids major surgery and results in rapid return to normal daily living 40 . Operating times and hospital stays are shorter, and recovery 41 and return to sexual intercourse 23 are quicker. It is a relatively safe operation with low levels of morbidity and mortality 42 .…”