GYNECOLOGICAL SURGERY AFTER ENDOMETRIAL ABLATION

Objective: To determine the number of patients requiring further gynaecological surgery after endometrial ablation. Design: A retrospective 20-26-month follow-up of private patients who underwent endometrial ablation, tracking subsequent surgical procedures through the Medicare database. Data were analysed on a national and State basis. Setting and participants: 1853 private patients who had had an endometrial ablation from 1 April 1991 to 30 September 1991. Seven different groups of subsequent gynaecological surgical procedures were investigated. Main outcome measures: The need for subsequent endometrial ablation, hysterectomy (by any means) and other forms of gynaecological surgery within the defined time period. Results: After initial ablation, 382 patients (21%) required further gynaecological surgery: 10% required hysterectomy; 6% required repeat ablation; and 5% of patients required other gynaecological procedures related to the uterus. These rates for further procedures were generally higher than reported previously after transcervical hysteroscopic endometrial ablation or resection. Conclusions: Endometrial ablation is associated with a significant medium and long term failure rate, necessitating further intervention. This failure rate may have been previously underestimated, and our higher rate may still be an underestimate.