Transcervical hysteroscopic resection of submucous leiomyomas: long-term results

Study aim: to evaluate the fellow-up after operative hysteroscopic resection of submucous leiomyomas. Patients and methods: Between January 1990 and December 1996, 200 patients underwent operative hysteroscopic resection of 289 uterine leiomyomas. Indications were: menometrorrhagia (n = 159), postmenopausal metrorrhagia (n = 22), infertility (n = 19) as sole etiology, Sixteen patients had infertility and menometrorrhagia. Results: The mean follow-up was 33.4 +/- 19.2 months. Twenty-three patients were lost to follow-up. Due to the la:ge size of the leiomyomas, 35 patients had 2 or 3 resections and a total of 241 hysteroscopic resections were performed; Twelve complications (5%) occurred with out death or need for intensive care, An improvement of clinical symptoms was observed in 74% of patients. The predictive factors of failure were: size (> 5 cm), number of intracavitary leiomyomas (> 3), hysterometry (> 12 cm), intramural myoma class 2 and association of leiomyomas, Eight of the 35 infertile patients subsequently became pregnant, but with only two live births (5.8%). Conclusion: Hysteroscopic myomectomy appears to be safe, effective and reproducible for the treatment of menstrual disorders. Intramural class 2 and larger leiomyomas constitute the limits of the endoscopic technique, (C) 2001 Editions scientifiques Et medicales Elsevier SAS.