Risk of uterine perforation during hysteroscopic surgery.

STUDY

OBJECTIVE

To evaluate the rate of uterine perforation during different operative hysteroscopy procedures.

DESIGN

Observational study (Canadian Task Force classification II-2).

SETTING

Department of Obstetrics and Gynecology, La Conception Hospital, Marseille, France.

PATIENTS: One thousand nine hundred fifty-two women.

INTERVENTION: Of 2116 operative hysteroscopies performed, there were 623 endometrectomies, 782 myoma resections, 422 polyp resections, 199 adhesiolyses, and 90 uterine septa sections.

MEASUREMENTS AND MAIN

RESULTS

Risk of perforation was evaluated according to hysteroscopic procedure. Severity of complications were also noted. In case of perforation, a management protocol was applied to prevent metabolic disorders and pelvic infections. Thirty-four perforations (1.61%) were reported. In 33 cases (97%) it was realized during the procedure and no complications occurred during follow-up. One perforation with hemorrhage was misdiagnosed during the intervention and required laparotomy. Perforation risk was higher during hysteroscopic adhesiolysis than during other procedures [endometrial ablation RR 9.39 (3.46-25.52), p <0.0001; uterine septa section RR 6.78 (0.91-50.6), p = 0.026; polyp RR 8.52 (2.60-30.80), p <0.0001 or myoma resection RR 7 (2.83-17.62), p <0.0001]. Perforation risk was comparable during endometrial ablation, uterine septa section, and polyp or myoma resection (p = 0.93).

CONCLUSION

Perforation risk is higher during synechiolysis than in other indications for hysteroscopy. Severe complications are rare but may be avoided if precautions are taken.