Endometrial ablation; less is more? Historical cohort study comparing long-term outcomes from two time periods and two treatment modalities for 854 women

Background: Abnormal uterine bleeding needs surgical treatment if medical therapy fails. After introduction of non-hysteroscopic endometrial ablation as alternative to hysteroscopic endometrial resection, we aimed to compare short and long-term outcomes for women treated with these two minimally-invasive procedures. A secondary goal was comparing the present cohort to a previous cohort of women treated with hysteroscopic resection only. Materials and methods: Historical cohort study of women treated for abnormal uterine bleeding with hysteroscopic resection or endometrial ablation at Haukeland University Hospital during 2006–2014. Similar patient file and patient-reported outcome data were collected from 386 hysteroscopic resections in a previous cohort (1992–1998). Categorical variables were compared by Chi-square or Fisher´s Exact-test, linear variables by Mann-Whitney U-test and time to hysterectomy by the Kaplan-Meier method. Results: During 2006–2014, 772 women were treated with endometrial resection or ablation, 468 women (61%) consented to study-inclusion; 333 women (71%) were treated with hysteroscopic resection and 135 (29%) with endometrial ablation. Preoperative characteristics were significantly different for women treated with hysteroscopic resection compared to endometrial ablation in the 2006-2014-cohort and between the two time-cohorts regarding menopausal, sterilization and myoma status (p≤0.036). The endometrial ablation group had significantly shorter operation time, median 13 minutes (95% Confidence Interval (CI) 12–14) and a lower complication rate (2%) versus operation time, median 25 minutes (95% CI 23–26) and complication rate (13%) in the hysteroscopy group, all p ≤0.001. The patient-reported rate of satisfaction with treatment was equivalent in both groups (85%, p = 0.955). The endometrial ablation group had lower hysterectomy rate (8% vs 16%, p = 0.024). Patient-reported satisfaction rate was higher (85%) in the 2006-2014-cohort compared with the 1992-1998-cohort (73%), p<0.001. Conclusions: Endometrial ablation has similar patient satisfaction rate, but shorter operation time and lower complication rate and may be a good alternative to hysteroscopic resection for treatment of abnormal uterine bleeding.publishedVersio

Stentgraftbehandling av thorakal aortasjukdom

Dei siste 10 åra har thorakale endograft vorte eit alternativ til open operasjon av thorakal aortasjukdom ved Universitetssykehuset Nord-Norge (UNN). I denne studia presenterast resultata frå desse 10 åra. Materiale og metode: Retrospektivt har pasientjournalar vorte gjennomgått. I perioda 1999 til 2009 vart 59 pasientar behandla med endovaskulære stentgraft. 42 av desse var menn. Gjennomsnittsalder var 65,3 år (7-85). Indikasjon for inngrepet var degenerative aneurismar (n=32), B-disseksjonar (n=14), traume (n=7), ulcus aorta (n=4) og mykotiske aneurismar (n=2). 34 pasientar vart behandla akutt. Oppfølgjing vart gjort med kontrast CT etter 1,3,6 og 12 mnd. Deretter årleg. Klinisk kontroll og CT vart utført ved lokalsjukehusa, og sendt elektronisk til UNN for vurdering. 2 pasientar var ikkje heimehøyrande i regionen, og vart difor ikkje inkludert i oppfølgjinga. Median oppfølgjingstid var 28 mnd. Resultat: 6 pasientar døydde innan 30 dagar. 4 av desse var akuttbehandla. 24 pasientar fekk dekt venstre arteria subclavia. 7 av 24 fekk utført bypass eller chimney prosedyre, og ingen av desse 7 fekk slag. Totalt 3 pasientar fekk major slag. Alle desse 3 fekk dekt venstre arteria subclavia utan bypass. 4 pasientar fekk minor slag. Av desse fekk 1 dekt venstre arteria subclavia utan bypass. 2 pasientar vart paraplegiske etter inngrepet. Der vart utført 12 reintervensjonar etter mediantid 14 mnd(1-83). Konklusjon: Endograft er ei trygg prosedyre for thorakal aortasjukdom. Venstre arteria subclavia bør ikkje dekkjast utan samtidig utført bypass eller chimney prosedyre

Endometrial ablation; less is more? Historical cohort study comparing long-term outcomes from two time periods and two treatment modalities for 854 women

Background: Abnormal uterine bleeding needs surgical treatment if medical therapy fails. After introduction of non-hysteroscopic endometrial ablation as alternative to hysteroscopic endometrial resection, we aimed to compare short and long-term outcomes for women treated with these two minimally-invasive procedures. A secondary goal was comparing the present cohort to a previous cohort of women treated with hysteroscopic resection only. Materials and methods: Historical cohort study of women treated for abnormal uterine bleeding with hysteroscopic resection or endometrial ablation at Haukeland University Hospital during 2006–2014. Similar patient file and patient-reported outcome data were collected from 386 hysteroscopic resections in a previous cohort (1992–1998). Categorical variables were compared by Chi-square or Fisher´s Exact-test, linear variables by Mann-Whitney U-test and time to hysterectomy by the Kaplan-Meier method. Results: During 2006–2014, 772 women were treated with endometrial resection or ablation, 468 women (61%) consented to study-inclusion; 333 women (71%) were treated with hysteroscopic resection and 135 (29%) with endometrial ablation. Preoperative characteristics were significantly different for women treated with hysteroscopic resection compared to endometrial ablation in the 2006-2014-cohort and between the two time-cohorts regarding menopausal, sterilization and myoma status (p≤0.036). The endometrial ablation group had significantly shorter operation time, median 13 minutes (95% Confidence Interval (CI) 12–14) and a lower complication rate (2%) versus operation time, median 25 minutes (95% CI 23–26) and complication rate (13%) in the hysteroscopy group, all p ≤0.001. The patient-reported rate of satisfaction with treatment was equivalent in both groups (85%, p = 0.955). The endometrial ablation group had lower hysterectomy rate (8% vs 16%, p = 0.024). Patient-reported satisfaction rate was higher (85%) in the 2006-2014-cohort compared with the 1992-1998-cohort (73%), p<0.001. Conclusions: Endometrial ablation has similar patient satisfaction rate, but shorter operation time and lower complication rate and may be a good alternative to hysteroscopic resection for treatment of abnormal uterine bleeding