Endocrine Abstracts

Objective: To determine the frequency of complications after hysteroscopic surgery and to analyze the risk factors associated with these complications.

Materials and Methods: We retrospectively analyzed outcomes in 2,650 patients who underwent hysteroscopic surgery at Asan Medical Center between January 1996 and September 2023.

Results: Indications for hysteroscopic surgery included submucosal myoma on ultrasonography in 910 patients, space-occupying lesion in the endometrial cavity on ultrasonography in 1,392, abnormal uterine bleeding in 57, uterine synechiae in 221, uterine septum in 25, and removal of intrauterine device in 30. Mean patient age was 40 years (range, 12-74 years). One hundred forty eight patients had a previous history of uterine surgery (cesarean section in 128 and myomectomy in 20). Operative complications occurred in 80 patients (3.02%), including 30 with uterine perforations, 38 with excessive bleeding, and 12 with postoperative infections. In univariable analysis, age ≥40 years (P=0.002), nulliparity (P=0.008), and body mass index <20 kg/m², and distension media volume ≥2,040 ml (P=0.008) were significantly associated with a higher risk of complications, but menopause, previous history of uterine surgery, use of Laminaria or misoprostol, type of distension media, postoperative compression of the endometrial cavity, and operating time were not. In multivariable analysis, body mass index <20 kg/m² (OR, 2.97; 95% CI, 1.41-6.22; P=0.004) and distension media volume ≥2,010 ml (OR, 2.56; 95% CI, 1.22-5.36; P=0.013) were significantly associated with increased risk of complications. Of several types of surgical procedures, hysteroscopic polypectomy was associated with significantly lower (odds ratio, 0.367; 95% CI, 0.161-0.835; P=0.017) and hysteroscopic adhesiolysis with significantly higher (odds ratio, 3.521; 95% CI, 1.525-8.127; P=0.003) risks of complications.

Conclusion: Hysteroscopic surgery is a safe procedure, with a very low (3.02%) complication rate. Body mass index <20 kg/m² and distension media volume ≥2,040 ml, and hysteroscopic adhesiolysis were associated with higher risks of complications, but hysteroscopic polypectomy was associated with a lower risk of complications.

Keywords: hysteroscopy; hysteroscopic surgery; complication; frequency; risk factor