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Endometrial ablation and resection / resection of polyp or fibroid


Insurance code: Q1700

Introduction: This information is written by John Fairbank and is provided for the benefit of his patients. Additional information will be given during consultation in the clinic and during the pre-operative discussion. It is not appropriate for all surgeons’ individual practice or for all patients.

Purpose of operation: Endometrial ablation is offered to women who have been suffering from heavy periods for whom other non-surgical treatments such as the Mirena coil have not been successful or appropriate. Endometrial fibroids or polyps can make periods much heavier and removing these small benign growths tends to make periods much lighter and less painful.
Description of procedure: Endometrial ablations with resection or roller-ball diathermy are surgical manoeuvres which destroy the endometrial tissue inside the uterus responsible for producing periods. Removing this layer totally or in part either stops periods or reduces the volume of blood loss. A telescope called a hysteroscope is passed into the uterine cavity from below and the endometrium is destroyed under direct vision by either resecting it away with a hot wire loop or by application of heat from a hot roller ball which is run over the uterine cavity. When there is a distinct polyp or fibroid the small fleshy growth is resected in slices with a small shaving wire loop which cuts through the fibroid tissue in small pieces. These small pieces of tissue are removed for histology.

Anaesthetic: These operations are normally carried out under a light general anaesthetic.

Length of stay: These operations are normally carried out as a day case but some patients prefer to stay overnight.

Post-operative management: A short course of anti-biotics is sometimes prescribed. Sex and tampon usage are avoided in the first 4 weeks to reduce the risk of infection.

Potential complications: Complications with these procedures are fortunately rare. The risk of heavy bleeding is greater with the larger fibroid polyps and very vascular polyps can not always be removed safely. Heavy bleeding which occurs during the operation can usually be controlled by the insertion of a catheter into the uterus. The balloon on the catheter is filled up with water which provides pressure on the cavity and reduces bleeding. The catheter is removed the following day. If the catheter technique does not work it is sometimes necessary to carry out a hysterectomy to prevent heavy loss. This is fortunately rare. If the surgical instruments perforate the uterine wall there is a risk of damage to structures inside the abdominal cavity. This is the rarest but the most important of the potential complications and if it occurs it is important to open the abdominal cavity and repair any damage that has occurred. In this situation it is usually necessary to carry out a hysterectomy with a five day stay and six week convalescence. This complication occurs in less than 1/200 cases (0.5%). Fluid absorption occurs as the endometrium or polyps are being removed and the procedure needs to be stopped if more than one litre of fluid has been absorbed. An additional blood test is then required to check the blood chemistry is normal before discharge home.

Post-operative consultation
It is usual to have a post-operative consultation about three months after the surgery. This follow up appointment is either with the gynaecologist or with the GP. By then it would be normal to have had three periods and possible to tell whether the operation has been successful. The overall satisfaction rate is over 95%.

Long term considerations
Fibroid and polyp removal will make periods lighter but not stop them completely. Endometrial ablation and resection can stop heavy periods for many years but then they may recur due to re-growth of the endometrium inside the uterus. This is fortunately rare but if it occurs a further endometrial ablation can be carried out. Periods can sometimes remain very light but can become very painful due to blood getting trapped inside the endometrial cavity and failing to drain out of the uterus. Dilating the cervix can sometimes relieve this problem. If this does not work a hysterectomy can be carried out as a final solution.

Return to normal activity and work
Most ladies require about three days off work and normal activity to recover although a few ladies will go back to work the next day and a few ladies will require a week off work.

Other websites to review:
Further relevant information is available via the following web sites:

1. Information on hysteroscopy

2. Information on fibroids and Mirena IUS

3. Information on Hysteroscopy

4. Some information about endometrial ablation

5. Some information about Novasure endometrial ablation