- Email: [email protected]
Asherman Surgery in the Netherlands 2003-2013
S138
Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S136–S190
455 Efficacy of Hysteroscopic Endometrial Resection in the Management of Abnormal Uterine Bleeding (AUB) Elbareg AM,1 Essadi FM,1 Anwar KI.2 1Obstetrics & Gynaecology, Misurata Central Hospital, Misurata, Libyan Arab Jamahiriya; 2 Obstetrics and Gynaecology, Iben-Sina Teaching Hospital, Sirt, Libyan Arab Jamahiriya Study Objective: To evaluate the effectiveness & outcomes of hysteroscopic endometrial resection (ER) in patients with AUB. Design: Prospective controlled study. Setting: Teaching hospitals in Misurata & Sirt , Libya. Patients: Total of 165 patients with AUB undergone hysteroscopic ER were enrolled in the study between January 2009 to December 2013. Intervention: 42 of them had hysteroscopic myomectomy. Specimens sent for histopathology. Mean age 42.5 years, average parity of 5.2 childbirths. All had detailed history, physical examination, ultrasound, diagnostic hysteroscopy & biopsy. Associated uterine pathology were considered. Inclusion criteria: failure or contraindication of medical treatment. Uterine size > 12 weeks pregnancy, large fibroid, atypical endometrial hyperplasia or carcinoma excluded. No medications before surgery to facilitate procedure. Outcomes included: menstrual flow reduction, pain degree, need of second operation, patient satisfaction, short & long-term complications. Statistical analysis performed using SPSS package. P-value to be significant if (\ 0.05). Measurements and Main Results: All ER performed without complications. Mean operating time 30 minutes, mean blood loss 12 ml. Mean follow-up period 18 months. 37 patients were lost to follow up. Of the remainder: 34(26.6%) showed amenorrhea while 64 (50%) hypomenorrhea. Treatment failed in 30 patients (23.4% ): 28 (21.9%) submitted to hysterectomy, remaining 2 (1.66%) had repeated ER. Satisfied patients 105 (82%), unsatisfied: bleeding & pain 23 (18%). Success rate significantly higher (P \ 0.05) in older age group ( > 40 years): success in 73 out of 82 (89%) versus those (\ 40 years): 32 out of 46 (69.6%). Success rate in myoma patients; (54.8%): (23 patients only from 42) in comparison to those without (73 out of 86) (84.9%)( P \ 0.05). Conclusion: ER is an effective alternative to hysterectomy in majority of women with AUB of benign etiology, especially when performed in those over age of 40 and without an increase in uterine size and have no fibroids.
adhaesions spontaneously recurred in 129 cases (21.4 %). First trimester curettages were prone to cause more low grades adhaesions (Grade 1-2a) and post partum procedures more high grades adhaesions (Grade3-5). Conclusion: Centralization of hysteroscopic adhaesiolysis in Asherman patients seems to have a positive effect on surgical outcome. Success rates are higher than reported in the literature. Primary prevention should be focussed on minimalizing the damage to the uterine cavity in post partum procedures. Secondary prevention measures after hysteroscopic adhaesiolysis should be evaluated, preferably by Randomised Controlled Trials since the recurrence rates are high, notwithstanding initially normalisation of the uterine cavity. 457 Use of Suction Curettage for Endometrial Polyps Farrow MR, Tam J, Nimaroff ML. Obstetrics & Gynecology, North Shore University Hospital, Manhasset, New York Study Objective: To describe the utilization of suction curettage as a method for treatment of multiple endometrial polyps or diffusely polypoid endometrium. Design: Case series. Setting: Tertiary medical center. Patients: Women undergoing hysteroscopy for abnormal uterine bleeding and/or endometrial polyps. Intervention: Patients underwent routine workup for irregular bleeding and/or thickened endometrium. They were scheduled for operative hysteroscopy and removal of polyps. At the time of the hysteroscopy these patients were found to have diffusely polypoid endometrium, without evidence of a discrete polyp. Patients then underwent suction curettage for removal of multiple polyps and polypoid tissue.
456 Asherman Surgery in the Netherlands 2003-2013 Emanuel MH, Hanstede M. Ob/Gyn, Spaarne Hospital, Hoofddorp, NH, Netherlands Study Objective: To report on hysteroscopic adhaesiolysis in patients with Asherman syndrome in the Netherlands after centralization. To analyze success rates of restoring the normal uterine cavity anatomy and restoring normal bleeding patterns. To assess the occurrence of early and late recurrence of adhaesions. Design: Retrospective cohort study. Setting: All patients where operated in the Spaarne Ziekenhuis, a university affiliated (University of Amsterdam and Free University Amsterdam) training hospital. Patients: Women with Asherman syndrome who were referred by gynaecologists, by general practitioners or by themselfs to the Spaarne Ziekenhuis. Intervention: A cohort from 2003-2013 was analysed. A total 638 women were included. All patients had hysteroscopic adhaesiolysis to remove intra uterine adhaesions and to restore the normal uterine cavity anatomy. Operative hysteroscopy with conventional instruments in combination with intraoperative fluoroscopy was performed in all cases. Measurements and Main Results: In 594 (94.7%) of the patient, a normal uterine cavity was restored in 1 to 3 attempts. In these patients
Measurements and Main Results: Hysteroscopic assessment of the endometrial cavity after suction curettage revealed complete resection of polypoid tissue without the need for hysteroscopic resection.
Conclusion: In our practice we use this established but underutilized technique whenever we encounter multiple polyps or diffusely polypoid tissue. We found decreased operative times and the ability to perform successive polypectomies quickly in a busy ambulatory surgery center.
Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S136–S190
455 Efficacy of Hysteroscopic Endometrial Resection in the Management of Abnormal Uterine Bleeding (AUB) Elbareg AM,1 Essadi FM,1 Anwar KI.2 1Obstetrics & Gynaecology, Misurata Central Hospital, Misurata, Libyan Arab Jamahiriya; 2 Obstetrics and Gynaecology, Iben-Sina Teaching Hospital, Sirt, Libyan Arab Jamahiriya Study Objective: To evaluate the effectiveness & outcomes of hysteroscopic endometrial resection (ER) in patients with AUB. Design: Prospective controlled study. Setting: Teaching hospitals in Misurata & Sirt , Libya. Patients: Total of 165 patients with AUB undergone hysteroscopic ER were enrolled in the study between January 2009 to December 2013. Intervention: 42 of them had hysteroscopic myomectomy. Specimens sent for histopathology. Mean age 42.5 years, average parity of 5.2 childbirths. All had detailed history, physical examination, ultrasound, diagnostic hysteroscopy & biopsy. Associated uterine pathology were considered. Inclusion criteria: failure or contraindication of medical treatment. Uterine size > 12 weeks pregnancy, large fibroid, atypical endometrial hyperplasia or carcinoma excluded. No medications before surgery to facilitate procedure. Outcomes included: menstrual flow reduction, pain degree, need of second operation, patient satisfaction, short & long-term complications. Statistical analysis performed using SPSS package. P-value to be significant if (\ 0.05). Measurements and Main Results: All ER performed without complications. Mean operating time 30 minutes, mean blood loss 12 ml. Mean follow-up period 18 months. 37 patients were lost to follow up. Of the remainder: 34(26.6%) showed amenorrhea while 64 (50%) hypomenorrhea. Treatment failed in 30 patients (23.4% ): 28 (21.9%) submitted to hysterectomy, remaining 2 (1.66%) had repeated ER. Satisfied patients 105 (82%), unsatisfied: bleeding & pain 23 (18%). Success rate significantly higher (P \ 0.05) in older age group ( > 40 years): success in 73 out of 82 (89%) versus those (\ 40 years): 32 out of 46 (69.6%). Success rate in myoma patients; (54.8%): (23 patients only from 42) in comparison to those without (73 out of 86) (84.9%)( P \ 0.05). Conclusion: ER is an effective alternative to hysterectomy in majority of women with AUB of benign etiology, especially when performed in those over age of 40 and without an increase in uterine size and have no fibroids.
adhaesions spontaneously recurred in 129 cases (21.4 %). First trimester curettages were prone to cause more low grades adhaesions (Grade 1-2a) and post partum procedures more high grades adhaesions (Grade3-5). Conclusion: Centralization of hysteroscopic adhaesiolysis in Asherman patients seems to have a positive effect on surgical outcome. Success rates are higher than reported in the literature. Primary prevention should be focussed on minimalizing the damage to the uterine cavity in post partum procedures. Secondary prevention measures after hysteroscopic adhaesiolysis should be evaluated, preferably by Randomised Controlled Trials since the recurrence rates are high, notwithstanding initially normalisation of the uterine cavity. 457 Use of Suction Curettage for Endometrial Polyps Farrow MR, Tam J, Nimaroff ML. Obstetrics & Gynecology, North Shore University Hospital, Manhasset, New York Study Objective: To describe the utilization of suction curettage as a method for treatment of multiple endometrial polyps or diffusely polypoid endometrium. Design: Case series. Setting: Tertiary medical center. Patients: Women undergoing hysteroscopy for abnormal uterine bleeding and/or endometrial polyps. Intervention: Patients underwent routine workup for irregular bleeding and/or thickened endometrium. They were scheduled for operative hysteroscopy and removal of polyps. At the time of the hysteroscopy these patients were found to have diffusely polypoid endometrium, without evidence of a discrete polyp. Patients then underwent suction curettage for removal of multiple polyps and polypoid tissue.
456 Asherman Surgery in the Netherlands 2003-2013 Emanuel MH, Hanstede M. Ob/Gyn, Spaarne Hospital, Hoofddorp, NH, Netherlands Study Objective: To report on hysteroscopic adhaesiolysis in patients with Asherman syndrome in the Netherlands after centralization. To analyze success rates of restoring the normal uterine cavity anatomy and restoring normal bleeding patterns. To assess the occurrence of early and late recurrence of adhaesions. Design: Retrospective cohort study. Setting: All patients where operated in the Spaarne Ziekenhuis, a university affiliated (University of Amsterdam and Free University Amsterdam) training hospital. Patients: Women with Asherman syndrome who were referred by gynaecologists, by general practitioners or by themselfs to the Spaarne Ziekenhuis. Intervention: A cohort from 2003-2013 was analysed. A total 638 women were included. All patients had hysteroscopic adhaesiolysis to remove intra uterine adhaesions and to restore the normal uterine cavity anatomy. Operative hysteroscopy with conventional instruments in combination with intraoperative fluoroscopy was performed in all cases. Measurements and Main Results: In 594 (94.7%) of the patient, a normal uterine cavity was restored in 1 to 3 attempts. In these patients
Measurements and Main Results: Hysteroscopic assessment of the endometrial cavity after suction curettage revealed complete resection of polypoid tissue without the need for hysteroscopic resection.
Conclusion: In our practice we use this established but underutilized technique whenever we encounter multiple polyps or diffusely polypoid tissue. We found decreased operative times and the ability to perform successive polypectomies quickly in a busy ambulatory surgery center.