Probability of Hysterectomy After Endometrial Ablation

Longinotti, Mindyn K.; Jacobson, George; Hung, Yun Yi; Learman, Lee A.

doi:10.1097/aog.0b013e31818c1766

Cited by 128 publications

(62 citation statements)

References 24 publications

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“…Furthermore, the previous observational studies may not have been restricted to women with HMB as the primary diagnosis. The proportion of women who had fibroids at the time of initial surgery was 20% among the Californian women, 10 whereas it was coded as a secondary diagnosis in only 4% of women in our cohort. Women who have HMB and concurrent conditions such as fibroids are indeed more inclined to have hysterectomy than women who have only HMB.…”

Section: Discussionmentioning

confidence: 92%

“…7,10 A Scottish study of 14 078 women reported that 16% of women underwent a hysterectomy in the first 2 years after an initial EA performed between 1989 and 2006. 7 A study of 3681 Californian women who had an initial EA between 1999 and 2004 estimated the risk of hysterectomy after 2 years to be 14%.…”

Section: Introductionmentioning

confidence: 99%

“…7 A study of 3681 Californian women who had an initial EA between 1999 and 2004 estimated the risk of hysterectomy after 2 years to be 14%. 10 In this study, we evaluate the risk of further gynaecological surgery for women in England who have had an initial EA for the treatment of HMB using a large national data set. We also investigate whether particular patient characteristics, including age and socio-economic deprivation, are associated with the risk of further surgery.…”

Section: Introductionmentioning

confidence: 99%

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Rates of subsequent surgery following endometrial ablation among English women with menorrhagia: population‐based cohort study

Bansi‐Matharu

Gurol‐Urganci

Mahmood

et al. 2013

BJOG

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Objective To assess the risk of further surgery amongst women who had an initial endometrial ablation (EA) for the treatment of heavy menstrual bleeding (HMB).Design A retrospective cohort study using a national administrative database.Setting Population-based study of hospital care in the English National Health Service. Methods Multiple Cox regressions were performed to identify the risks of a further procedure, adjusted for age, social deprivation, year and type of initial EA, and presence of fibroids/polyps.Main outcome measures Time to repeat EA or hysterectomy after initial surgery.Results Of 114 910 women undergoing EA, 16.7% had at least one subsequent procedure within 5 years. Higher rates of subsequent surgery were associated with younger age at initial EA, with women aged under 35 years having an adjusted hazard ratio of 2.83 (95% CI 2.67-2.99), compared with women aged over 45 years. Women who had radiofrequency ablation were less likely to have subsequent surgery as compared with first-generation techniques (HR 0.69, 95% CI 0.63-0.76). The rate of a subsequent hysterectomy within 5 years was 13.5%. Younger women (OR 0.59, 95% CI 0.51-0.69) and those who had balloon, microwave, or radiofrequency ablation were less likely to have a second EA procedure, rather than a hysterectomy.Conclusions One in six women have further surgery after EA for HMB, which is a higher rate than reported in clinical trials. This risk of further surgery decreases with age.Keywords Endometrial ablation, heavy menstrual bleeding, hysterectomy.Please cite this paper as: Bansi-Matharu L, Gurol-Urganci I, Mahmood T, Templeton A, van der Meulen J, Cromwell D. Rates of subsequent surgery following endometrial ablation among English women with menorrhagia: population-based cohort study. BJOG 2013;120:1500-1507.

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Rates of subsequent surgery following endometrial ablation among English women with menorrhagia: population‐based cohort study

Bansi‐Matharu

Gurol‐Urganci

Mahmood

et al. 2013

BJOG

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“…Shavell et al found that, through five years of follow-up, hysterectomy was performed subsequently to endometrial ablation in 13.4% of the cases, primarily due to persistent bleeding and pelvic pain [24]. Longinotti et al, in 8-year follow-up of 754 women, reported a 26% probability of hysterectomy subsequent to endometrial ablation, with pelvic pain being the main reason for the procedure in 22% of the cases [25]. According to the literature, reduced bleeding or infrequent menstruation is achieved in 48% -60%, absence of menstruation in During postoperative follow-up, 5 patients (3 from group A and 2 from group B) underwent hysterectomy, and 1 patient from group B had an endometrial reablation.…”

Section: Discussionmentioning

confidence: 99%

Comparative Study between Endometrial Resection and Electrocoagulation in Patients with Abnormal Uterine Bleeding

Elias¹,

Dias²,

Leite³

et al. 2017

OJOG

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Objective: To compare clinical outcomes between two first-generation endometrial ablation techniques. Design: Prospective comparative coorte. Setting: Tertiary public hospital, university teaching center. Seventy-three patients with abnormal uterine bleeding unresponsive to clinical treatment submitted to endometrial ablation from October 2011 to September 2013. Methods and Main Outcome Measures: Patients were assigned to either monopolar U-shaped electrode resection with rollerball electrocoagulation (group A, n = 36) or rollerball electrocoagulation alone (group B, n = 37). Mean follow-up length was 359 (280 -751) and 370 days (305 -766) in groups A and B, respectively. Bleeding pattern, associated symptoms, failure/success rates were assessed 30, 90, 180 and 360 days post-procedure. Findings: Patient characteristics were similar in both groups (P ≥ 0.05). Surgery duration (mean of 48.5 [±12.0] vs. 31.9 [±5.6] min, P < 0.001) and medium distention use (5.700 mL vs. 3.500 mL, P < 0.01) were decreased in group B. Post-ablation clinical improvement was considerable in both groups. Vaginal discharge incidence after the procedure was lower in group B (30.5% vs. 8.1%, P < 0.05). Hysterectomy rate was 9.6%. Overall success rate was 86.1% and 88.1% in groups A and B, respectively. Conclusions: Endometrial ablation using rollerball electrocoagulation alone may be considered safer than resection with rollerball electrocoagulation, which requires shorter surgical time and less distention medium, and is associated with lower postoperative vaginal discharge incidence. Success rate did not # Adjunct Professor III and Principal Investigator.How to cite this paper: Elias, L.V.,

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“…None of the studies reported satisfaction after second generation EA in the presence of intramural or subserosal fibroids; however, one study reported that the presence of a small fibroid uterus did not increase the hysterectomy rate. 117 We extrapolated from this and used the same data for small fibroid uteri as we did for satisfaction after second-generation EA for DUB. For large fibroid uteri we asked our expert panel their estimation of satisfaction rates, 1 year post EA in the absence of published data.…”

Section: Endometrial Ablationmentioning

confidence: 99%

Cost-effectiveness of diagnostic strategies for the management of abnormal uterine bleeding (heavy menstrual bleeding and post-menopausal bleeding): a decision analysis

Cooper

Barton

Breijer

et al. 2014

Health Technology Assessment

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Probability of Hysterectomy After Endometrial Ablation

Abstract: II.

Cited by 128 publications

References 24 publications

Rates of subsequent surgery following endometrial ablation among English women with menorrhagia: population‐based cohort study

Rates of subsequent surgery following endometrial ablation among English women with menorrhagia: population‐based cohort study

Comparative Study between Endometrial Resection and Electrocoagulation in Patients with Abnormal Uterine Bleeding

Cost-effectiveness of diagnostic strategies for the management of abnormal uterine bleeding (heavy menstrual bleeding and post-menopausal bleeding): a decision analysis

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