Surgical management of symptomatic uterine fibroids by abdominal myomectomy.
Material and methods: Authors review their experiences and surgical methods for 504 abdominal myomectomies performed over the last 15 years. They retrospectively analyze the annual number of myomectomies, the age distribution, the most frequent indications, the location, size, and number of leiomyomas, the number of cases in which the uterine cavity was opened, the frequency of post-operative complications, and the number and outcome of post-myomectomy pregnancies.
Results: The annual number of myomectomies increased 26 times over the 15 year period, the average age at myomectomy was 33 years, 1.8% of post-fertile patients desired surgery which allowed for conservation of the uterus. The three most frequent indications for myomectomy were abdominal pain, infertility and menorrhagia. Regarding location, size and number; 82.7% of fibroids were submucosal/intramural and/or larger than 7 cm and/or greater than three in number. The uterine cavity was opened in 112 cases (22.2%). Post-operative complications occurred in 67 cases (13.3%): 7.7% required transfusions, 2.2% needed repeat laparotomy, two of which resulted in hysterectomy, and fever occurred in 13 cases (3.0%). There were 122 (24.2%) pregnancies in 105 patients following myomectomy. Eighty-nine patients conceived once, 15 patients conceived twice and 1 patient conceived three times post-myomectomy. There were 26 spontaneous abortions representing 5.2% of the post-myomectomy patients and 21.3% of the conceived pregnancies. There were 96 deliveries in 19.0% of the patients who had myomectomy and 78.7% of the total conceived pregnancies.
Conclusion: Authors suggest that abdominal myomectomy for the therapy of symptomatic uterine fibroids is an effective surgical alternative to hysterectomy one, which preserves fertility and femininity. In cases where the fibroids have well-defined borders, the success of surgery does not depend on the location, size or number of fibroids. In cases with adenomyosis, myomectomy alone is not sufficient to alleviate the symptoms. When the uterine cavity is opened during surgery, post-operative transcervical drainage is suggested to prevent hematometra, post-operative adhesions inside the uterus, infection, fever and wound dehiscence.