199: Delayed Complication of Hysteroscopic Endometrial Resection: An Interesting Presentation

Oral Presentations hysteroscopy done with sonography guidance using portable 2D ultrasound under epidural anesthesia. Distention medium was normal saline. Measurements and Main Results: After hysteroscopic visualization of the shape and location of the IUD, Kocker forceps was used to extract a slightly embedded SAF T Coil IUD under transrectal sonogram guidance. The hysteroscope with grasping forceps through the operation channel was used to remove broken pieces of IUD string. Conclusion: Hysteroscopy is superior to Xray and ultrasound in the diagnosis and management of missing IUD. It appears to be indispensable and with ultrasound guidance it is the method of choice in locating missing IUD and removing embedded IUD, remnants and broken pieces. 198 Factors Which Affect Negatively the Outcome of Hysteroscopic Therapy for Intrauterine Adhesions March CM, Ringler GE. California Fertility Partners, Los Angeles, California Study Objective: The purpose of this study was to evaluate the effect of various etiologies and estrogen deficiency on the outcome of therapy for intrauterine adhesions (IUA). Design: Retrospective analysis of patients treated by one surgeon. Setting: Private practice. Patients: Eleven hundred fifty patients with IUA were separated into groups depending upon the antecedent factors [abortion, gynecologic surgery (GS) or curettage for a postpartum hemorrhage (PPC)]and the presence of estrogen deficiency [caused by a gonadotropin releasing hormone agonist (GnRHa) or prolonged breast feeding in those who were postpartum]. Intervention: Hysteroscopic adhesiolysis with or without simultaneous laparoscopy (LSC) followed by placement of a uterine stent and high dose estrogen therapy. Measurements and Main Results: The number and type procedures and the presence of hypoestrogenism was recorded. Outcome was judged by restoration of menses, by uterine architecture on an HSG, by a mid-cycle ultrasound and by the occurrence of pregnancy and it’s outcome. In the GS group, 30% required LSC, 25% underwent more than one procedure, 25% had a normal HSG and only 15% conceived. The use of a GnRHa prior to surgery worsened the prognosis. Among those whose antecedent factor was curettage for a postpartum hemorrhage, 40% required both more than one surgery and a simultaneous LSC. One-half of these women had a normal post-operative HSG and only one-third conceived. Breast feeding worsened the prognosis. Conclusion: Two factors have independent adverse effects upon the efficacy of treatment for IUA: scar formation after GS and prolonged estrogen deficiency prior to and after the initial etiologic surgery.

S73 199 Delayed Complication of Hysteroscopic Endometrial Resection: An Interesting Presentation Marcoux V, Ternamian A. St. Joseph’s Health Centre, Toronto, Ontario, Canada Study Objective: Hysteroscopic endometrial resection is an effective surgical treatment for abnormal uterine bleeding. This minimally invasive technique offers a good alternative to hysterectomy in women affected by this disorder. The authors describe a case report of a delayed complication, following hysteroscopic endometrial resection, presenting as a massive pelvi-abdominal mass suspicious of ovarian malignancy. Design: Case report and review of the literature. Setting: Community teaching hospital. Patient: Case report. Intervention: Six years following an uncomplicated hysteroscopic endometrial resection for menorrhagia, a 50 year old woman presents with two large multicystic tumors of pelvic origin. During surgery, they are discovered to originate from a defect in the uterine fundus. Intraoperative dissection reveals free communication between the uterine cavity and the masses. At histology, endometrial glands are identified to line the inner aspect of the masses while normal serosa covers the outer surface. The lower uterine segment is strictured half way down the endocervical canal. Measurements and Main Results: Late complications of hysteroscopic endometrial resection, including incomplete resection, pregnancy complications, hematometra, post-ablation tubal sterilization syndrome as well as endometrial cancers are reviewed. Their true incidence is difficult to determine, since they are mostly under-reported. The most common complication remains failure to treat the presenting symptoms. Overall, between 6 and 20% of patients will undergo a hysterectomy within five years of a hysteroscopic endometrial resection, for different reasons. Conclusion: The short-term safety of hysteroscopic endometrial ablation or resection is well documented. The delayed complications of hysteroscopic endometrial ablation using roller bar or loop resection are reviewed. 200 Peritoneal Lesions – Endometriosis or Other Problems? Martin DC, Davenport W. University of Tennessee, UT Medical Group, Inc., Germantown, Tennessee Study Objective: The purpose of this study is to analyze the recognition of endometriosis, endosalpingiosis, psammoma bodies, hemangiomas, Walthard cell nests and low malignant potential tumor (LMPT) seen at pelvic laparoscopy by obstetricians and gynecologists. Design: This is a survey study of management decisions based on laparoscopic appearances of lesions. Options included immediate treatment, delaying treatment for histology, notifying the patient immediately and deferring defin-