Where is the reasonable proportion between endometrectomy and different types of hysterectomy, including LAVH

After enthusiastic reports in the late 1980s, many authors are disappointed by the long term results of endometrectomy. In our first series of 75 patients, all followed for at least 60 months, we have had 71% good results, including treatment in uterine cavities over 10 cm. Avoiding treatment of cavities over 9 cm, we have had 85% good results (5 year follow-up). In cases of recurrence after endometrectomy, manifested by a larger uterus or additional pathology (pain and endometriosis), hysterectomy has been performed vaginally in 81% of the cases. In 50% of the women, laparoscopic assistance was performed; however, objective indications (adhesions, ovarian cyst, endometriosis) were found in only 17%. In 6% only, abdominal hysterectomy has been performed for poor vaginal access or uterine size over 14 cm. In cases of laparoscopic assistance, three second-look procedures have been done with two for hematoma of the vaginal cuff and one for abscess. We conclude that endometrectomy is the first choice in managing abnormal uterine bleeding under 10 cm; second choice is vaginal hysterectomy. Laparoscopic assistance was only necessary in the presence of adhesions, adnexal masses, or endometriosis.