Reoperative hysteroscopic surgery in the management of patients who fail endometrial ablation and resection

STUDY OBJECTIVE: To determine the safety and efficacy of reoperative hysteroscopic surgery for women who fail endometrial ablation and resection. DESIGN: Retrospective chart review and follow-up (Canadian Task Force classification II-2). SETTING: Private office practice. PATIENTS: Twenty-six women who had undergone endometrial ablation or resection and experienced failure characterized by intolerable pain, bleeding, or asymptomatic hematometra. INTERVENTION: Sonographically guided hysteroscopic endomyometrial resection. MEASUREMENTS AND MAIN RESULTS: Mean length of time from initial treatment for abnormal uterine bleeding and reoperative hysteroscopic surgery was 41.2 +/- 47.9 months. Five (19.2%) women required simple dilatation and 21 (80.8%) required endocervical resection to achieve access to the uterine cavity. There were no operative complications. Mean operating time was 20.3 +/- 9.5 minutes. Mean specimen weight was 6.7 +/- 4.9 g. Adenomyosis was present in 15 (57.7%) specimens. Women were followed for a mean of 23.2 +/- 22.7 months. Twenty-three (88.5%) achieved satisfactory results and avoided hysterectomy. Three women (11.5%) eventually required hysterectomy because of recurrent pain or bleeding. CONCLUSION: Reoperative hysteroscopy is useful in managing women after failed endometrial ablation and resection. It produces excellent results in achieving amenorrhea and relief of cyclic pelvic pain, thereby avoiding hysterectomy in most patients.