Hysteroscopic Endometrial Resection in the Management of Abnormal Uterine Bleeding Among Libyan Women
Keywords:
Uterine bleeding, hysteroscopic, endometrial resection, Libya
Abstract
Background: Abnormal uterine bleeding (AUB) is a major health problem and it is a substantial cause of ill health in women. Medical treatment has a high failure rate and adverse effects. There are few published data on hysteroscopic endometrial resection (HER) in the management of patients with AUB.
Objective: To investigate the efficacy and outcomes of hysteroscopic endometrial resection (HER) in patients with AUB.
Materials and Methods: A descriptive hospital - based study was carried out at the departments of Obstetrics and Gynecology, Misurata and Sirt, Libya, during the period from January 2009 to December 2013. Women with AUB were recruited in the study. All women had a detailed medical and obstetrical history, physical examination and the hysteroscopic endometrial ablation and were followed-up for success or failure of the procedure which was assessed via symptoms (bleeding).
Results: A total of 120 women with mean (SD) of age and parity of 42.3 (6.8) years and 3.8 (2.4), respectively were recruited in the study initially. Thirty (25%) of these women were lost of followup Therefore, only 70 women (50 with DUB, and 20 women with fibroids) were available for the final analysis. All women underwent hysteroscopic endometrial resection and 28 of them had hysteroscopic myomectomy. The success rate was 92.8% (65/70) after 2 years follow up. All the five women with failure of the procedure were younger (<40 years); had bleeding with dysmenorrhea, bigger uterine size, thicker endometrium (> 7 mm) and they had fibroids.
Conclusions: Endometrial resection is an effective procedure in the majority of women with AUB, especially in those over age of 40 and without an increase in uterine size and has no fibroids.
References
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29. Ergun B, Bastu E, Ozsurmeli M, Celik C .Tranexamic Acid: A Potential Adjunct to Resectoscopic Endometrial Ablation . IntSurg 2012;97:310–314
30. Shokeir T, Eid M, Abdel-Hady el-S. Does 7adjuvant long-acting gestagen therapy improve the outcome of hysteroscopic endometrial resection in women of low-resource settings with heavy menstrual bleeding? J Minim Invasive Gynecol 2013; 20(2); 222-6.
31. Loffer FD. A comparison of hysteroscopic techniques of endometrial ablation. Edinburgh: Churchill living stone; 1992: 143-150.
32. Rovio PH, Helin R, Heinonen PK. Long term outcome of hysteroscopic endometrial resection with or without myomectomy in patients with menorrhagia. Arch gynecolObstet 2009; 279(2):159-63.
33. Istre O, Langebrekke A. Repeat hysteroscopic surgery reduces the hysterectomy rate after endometrial and myoma resection. J Am AssocGynecolLaparosc 2003; 10(2):247-51.
34. Hansen BB, Dreisier E, StampeSqrensen S. Outcome of repeated hysteroscopic resection of the endometrium. J Minim Invasive Gynecol 2008; 15(6):704-6.
35. Litta P, Bartolucci C, Saccardi C, Codroma A, Fabris A, Borgato S, Conte L. Atypical endometrial lesions: hysteroscopic resection as an alternative to hysterectomy. Eur J GynecolOncol 2013; 34(1):51-3.
36. Levy-Zauberman Y, Fernandez H, Pourcelot AG, Legendre G. does repeated endometrial destruction procedures decreases abnormal uterine bleeding, and does it reduce the number of hysterectomy in this indication? J GynecolObstetBiolReprod 2014; 43(1):35-9.
2. Goldstein SR, Zeltser I, Horan CK, Snyder JR, Schwartz LB. Ultrasonography-based triage for perimenopausal patients with abnormal uterine bleeding. Am J ObstetGynecol 1997; 177(1):102- 108.
3. Lethaby A, Hickey M. Endometrial destruction techniques for heavy menstrual bleeding: a Cochrane review.Hum Reprod 2002;17(11):2795- 806
4. Lethaby A, Sheppered S, Cooke I, Farquhar C. Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding. The Cochrane Library, Issue 2, 2004.
5. Lethaby A, Duckitt K, Farquhar C. Non-steroidal anti-inflammatory drugs for heavy menstrual bleeding. Cochrane Database Syst Rev. 2013 Jan 31;1:CD000400
6. Beaumont H, Augood C, Duckitt K, Lethaby A. Danazol for heavy menstrual bleeding. Cochrane Database Syst Rev 2007; (3):CD001017.
7. Lethaby A, Irvine G, Cameron I. Cyclical Progestogens for heavy menstrual bleeding. Cochrane Database Syst Rev 2008; (1):CD001016.
8. Lethaby A, Hickey M, Garry R. Endometrial destruction techniques for heavy menstrual bleeding. Cochrane Database Syst Rev 2005; (4):CD001501.
9. Ghazizadeh S, Bakhtiari F, Rahmanpour H, Davari-Tanha F, Ramezanzadeh F. A randomized clinical trial to compare Levonorgestrel-releasing intrauterine system (Mirena) vs trans-cervicalendometrial resection for treatment of menorrhagia. Int J Women's Health 2011; 3: 207-11.
10. Matteson KA, Abed H, Wheeler II TL, Sung VW Rahn DD, Schaffer JI, Balk EM; Society of Gynecologic Surgeons Systematic Review Group. A systemic review comparing hysterectomy to less invasive treatments for abnormal uterine bleeding. J Minim Invasive Gynecol 2012; 19(1): 13-28.
11. Decherney AH, Diamond MP, Lavy G, Polan ML. Endometrial ablation for intractable uterine bleeding: hysteroscopic resection. ObstetGynecol 1987; 70:663-670.
12. Garry R. The benefits and problems associated with minimal access surgery. Aust N Z J ObstetGynaecol 2002; 42(3):239-44.
13. Overton C, Hargreaves J, Maresh M. A national survey of the complications of endometrial destruction for menstrual disorders: the MISTLETOE study. Minimally Invasive Surgical Techniques--Laser, EndoThermal or Endorescetion. Br J ObstetGynaecol 1997; 104(12):1351-9.
14. Lethaby A, Hickey M, Garry R, Penninx J. 7Endometrial resection/ablation techniques for heavy menstrual bleeding. Cochrane Database Syst Rev. 2009; 7;(4).
15. Dickersin K, Munro MG, Clark M, Langenberg P, Scherer R, Frick K, Zhu Q, Hallock L, Nichols J, Yalcinkaya TM; Surgical Treatments Outcomes Project for Dysfunctional Uterine Bleeding (STOP-DUB) Research Group. Hysterectomy compared with endometrial ablation for dysfunction uterine bleeding: a randomized controlled trial. ObstetGynecol 2007; 110:1279- 89.
16. Yeung T, Lau W, NG TK. Long-term outcome of hysteroscopic endometrial ablation in the treatment of dysfunctional uterine bleeding. Hong Kong J GynecolObstet Midwifery 2010; 10:37-44.
17. Takahashi WH, Lopes RG, DepesDde B, Martins e CastelloBranco HK. Results of hysteroscopic endometrial ablation after fiveyear follow-up. Rev Bras GinecolObstet 2012; 34(2):80-5.
18. Stamatellos I, Koutsougeras G, Karamanidis D, Stamatopoulos P, Timpanidis I, Bontis J. Results after hysteroscopic management of premenopausal patients with dysfunctional uterine bleeding or intrauterine lesions. ClinExpObstetGynecol 2007; 34(1):35-8.
19. Baggish MS and Szi HM. Endometrial ablation: series of 568 patients treated over an 11-year period. Am J ObstetGynecol 1996; 174(3) 908- 913.
20. Shamonki MI, Zeigler WF, Badher GJ, Sites GK. Prediction of endometrial ablation success according to preoperative findings. Am J ObstetGynecol 2000; 182:1005-1007.
21. Gemer O, Kapustain V, Kroll D, Tur-Kaspa I, Segal S. Preoperative factors for predicting successful hysteroscopic endometrial ablation. J Rep Med 2003; 48(9): 677-680.
22. Porturese A and Darta M. Treatment of adenomyosis associated menorrhagia with a levonorgestril releasing intrauterine device. FertilSteril 1997; 68: 426-429.
23. Basak S, Saha A. Adenomyosis: still largely under-diagnosed. J ObstetGynaecol 2009; 29(6):533-5.
24. Maia Hugo, Haddad C, Casoy J, Maia R, Pinheiro N, Coutinho EM. effect of a hormone-releasing intrauterine system (Mirena) on aromatase and Cox-2 expression in patients with adenomyosis submitted or not, to endometrial resection. Int J Womens Health 2012:4; 175-183.
25. Gemer O, Kruchkovich J, Huerta M, Kapustian V, Kroll D, Anteby E. Perioperative predictors of successful hysteroscopic endometrial ablation.Gyn ecolObstet Invest 2007; 63(4):205-8.
26. Tan YH1 , Lethaby A. Preoperative endometrial thinning agents before endometrial destruction for heavy menstrual bleeding. Cochrane Database Syst Rev 2013;11:CD010241.
27. Shawki O, Peter A, Abraham-Hebert S. Hysteroscopic endometrial destruction,. Optimum method for preoperative endometrial preparation: a prospective, randomized, multicenter evaluation. JSLS 2002; 6(1); 23-7.
28. Rosati M, Vigone A, Capobianco F, Surico D, Amoruso E, Surico N. Longterm outcome of hysteroscopic endometrialablatio n without endometrial preparation. Eur J ObstetGynecolReprodBiol 2008; 138(2):222-5.
29. Ergun B, Bastu E, Ozsurmeli M, Celik C .Tranexamic Acid: A Potential Adjunct to Resectoscopic Endometrial Ablation . IntSurg 2012;97:310–314
30. Shokeir T, Eid M, Abdel-Hady el-S. Does 7adjuvant long-acting gestagen therapy improve the outcome of hysteroscopic endometrial resection in women of low-resource settings with heavy menstrual bleeding? J Minim Invasive Gynecol 2013; 20(2); 222-6.
31. Loffer FD. A comparison of hysteroscopic techniques of endometrial ablation. Edinburgh: Churchill living stone; 1992: 143-150.
32. Rovio PH, Helin R, Heinonen PK. Long term outcome of hysteroscopic endometrial resection with or without myomectomy in patients with menorrhagia. Arch gynecolObstet 2009; 279(2):159-63.
33. Istre O, Langebrekke A. Repeat hysteroscopic surgery reduces the hysterectomy rate after endometrial and myoma resection. J Am AssocGynecolLaparosc 2003; 10(2):247-51.
34. Hansen BB, Dreisier E, StampeSqrensen S. Outcome of repeated hysteroscopic resection of the endometrium. J Minim Invasive Gynecol 2008; 15(6):704-6.
35. Litta P, Bartolucci C, Saccardi C, Codroma A, Fabris A, Borgato S, Conte L. Atypical endometrial lesions: hysteroscopic resection as an alternative to hysterectomy. Eur J GynecolOncol 2013; 34(1):51-3.
36. Levy-Zauberman Y, Fernandez H, Pourcelot AG, Legendre G. does repeated endometrial destruction procedures decreases abnormal uterine bleeding, and does it reduce the number of hysterectomy in this indication? J GynecolObstetBiolReprod 2014; 43(1):35-9.
