Endometrial Nd-YAG laser ablation by hysterofibroscopy: long-term results of 137 cases

Jourdain O, O Jourdain, Joyeux P, P Joyeux, Patrick Joyeux, Claire Lajus, C Lajus, Lajus C, I Sfaxi, Sfaxi I, Ihmed Sfaxi, Harle T, T Harle, Tania Harle, D Roux, Denis Roux, Roux D, Dallay D, D. Dallay
European journal of obstetrics, gynecology, and reproductive biology · 1996 · vol. 69(2) , pp. 103–107 · doi:10.1016/0301-2115(95)02510-3 · PMID:8902441 · W1982754342
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This paper reports on the long-term outcomes of 137 cases treated with hysterofibroscopic endometrial Nd-YAG laser ablation for abnormal uterine bleeding.

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Abstract

ObjectiveIn our gynecology department, we have been performing endometrial laser ablation (ELA) under video control using a flexible hysteroscope since 1989. The aim of this study is to evaluate the long term results of our experience.Study designWe went back to the files of 137 patients treated between 1989 and 1993. These women (mean age 42 years) exhibited menorrhagia unamenable to medical treatments which had been developing for 28 months. Mean hysterometry was 9.8 cm. A hysteroscopy with ELA was performed. Our procedure lasts 19 min on average and uses 0.9 1 of glycocol. There were no perforations. Six patients presented a fever above 38 degrees C within the next 48 h; only one developed a true endometritis necessitating antibiotherapy. One patient who had received several GnRH agonist courses had a coagulation of the uterus and had to be hysterectomised.ResultsNine patients were lost to follow-up; for the others, mean follow-up was 32 months. Seventeen women (13.3%) were hysterectomised, including the patient with a coagulation necrosis of the myometrium. In most cases, this was for undetected adenomyosis or fibromas evolving after hysteroscopy. Bleeding recurred in two other patients; they refused hysterectomy but should be counted as failures of this method. Among the 109 patients (85.1%) considered a success, 35 have had menopause since the procedure.ConclusionELA is a simple quick procedure which significantly reduces the number of hysterectomies. In addition, the economic value of ELA is beginning to be assessed in the literature. This long-term study should allow the indications to be better defined by eliminating patients with a high risk of failure and should lead to improved results.

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MeSH descriptors

Endometrium Laser Therapy Leiomyoma Menorrhagia Uterine Neoplasms Adult Endometrium Female Follow-Up Studies Humans Hysteroscopy Laser Therapy Laser Therapy Leiomyoma Menorrhagia Middle Aged Retrospective Studies Time Factors Uterine Neoplasms

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