Ultrasound-guided reoperative hysteroscopy for managing global endometrial ablation failures

Literature Review Article

  Ultrasound-guided reoperative hysteroscopy for managing global endometrial ablation failures. Wortman M, Daggett A, Deckman A. Minim Invasive Gynecol. 2013 In Press.

Review
Dr. John Preston Parry, M.D., M.P.H.
 

The article’s purpose is to address whether ultrasound-guided reoperative hysteroscopy can be used to treat menstrual issues arising after global endometrial ablation (GEA) instead of having to perform hysterectomy. Issues discussed in the paper include the use of both unipolar and bipolar electrosurgery, the dual monitor setup so hysteroscopic and sonographic images can be viewed easily and simultaneously, and other aspects of approach to the tubular cavity. The authors treated 50 women with this indication and approach, 47 (94%) of which were in the office-based setting and 3 (6%) in an ambulatory surgical setting. Using the described approach, 90% of women (44 of 49) did not require a second surgical procedure. Five women required additional surgery due to persistent severe cyclic pain despite amenorrhea or oligomenorrhea, and three had hysterectomies. Two of the hysterectomy specimens demonstrated adenomyosis and the third had leiomyomas with blood-filled cysts in the myometrium. The authors also found that more than half of GEA failures occurred in women with either submucosal fibroids or persistent functioning endometrium in the cornual region. In conclusion, they note that though their follow up was limited (averaging 18 months), reoperative hysteroscopy can be an effective alternative to hysterectomy in women with persistent symptoms after GEA.

Comments
Dr. Steven R. Lindheim, M.D., M.M.M.
 

GEA has emerged as a commonly used method for managing abnormal uterine bleeding in women  who have completed childbearing and are not candidates for medical management.  However, a significant number of women experience delayed complications resulting in one in four women undergoing hysterectomy within 4 years after GEA. While several limitations exist in this study including long-term follow-up and lack of randomization, ultrasound guided re-operative hysteroscopy appears to be a safe and effective minimally invasive alternative to hysterectomy in women who have experienced a delayed complication of GEA. 

The above review and commentary on this article were written by SRS members. Publication of these summaries does not reflect endorsement of any particular procedure or treatment. Views expressed in these summaries do not necessarily reflect the views of SRS or ASRM.

 

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