Myomectomy: Results and Complications
Uterine fibroids are common hormone sensitive benign tumours of the uterus, with a reported incidence of up to 30–40 % in women of reproductive age with variations depending on the age group and ethnic background. Although they are asymptomatic in many ca
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Contents
Abstract
1
Introduction.......................................................................... 125
2 2.1 2.2 2.3 2.4
Complications of Myomectomy.......................................... Open (Abdominal) Myomectomy ......................................... Laparoscopic Myomectomy .................................................. Vaginal Myomectomy ........................................................... Hysteroscopic Myomectomy.................................................
126 126 127 128 128
3 3.1 3.2 3.3 3.4 3.5 3.6
Results of Myomectomy...................................................... Results on Fertility ................................................................ Impact on Future Pregnancies............................................... Results on Recurrence of Fibroids ....................................... Risk of Malignancy ............................................................... Results on Menstrual/Uterine Bleeding................................ Results on Pelvic Pain and Bladder Symptoms ...................
129 129 130 131 131 131 131
4
Conclusion ............................................................................ 132
Uterine fibroids are common hormone sensitive benign tumours of the uterus, with a reported incidence of up to 30–40 % in women of reproductive age with variations depending on the age group and ethnic background. Although they are asymptomatic in many cases, the presence and persistence of clinical symptoms warrants medical or surgical intervention. Myomectomy is advisable for symptomatic women who want to preserve their uterus. Myomectomy can be performed trans-abdominally, laparoscopically, vaginally or hysteroscopically. The aim of this intervention is to alleviate any menstrual symptoms and improve fertility. Whatever the route of surgery, however, myomectomy is classified as a major operation which is associated with both short- and longterm complications which, in many respects, depend on the size, location and number of fibroids. Apart from risks such as infection, bruising, deep vein thrombosis, which apply to any major surgical procedure, complications range from major intra-operative blood loss, occasionally necessitating hysterectomy, to longer term problems of post-operative adhesions and fibroid recurrence. There are also route-specific potential complications related to the type of myomectomy.
References...................................................................................... 132
1
I. Tsimpanakos A. Magos (&) University Department of Obstetrics and Gynaecology, Royal Free Hospital, Pond Street, Hampstead, London, NW3 2QG, UK e-mail: [email protected]
Introduction
Uterine fibroids are the most common benign lesion found in women of reproductive age, with over 25 % of women in this age group reporting clinical symptoms related to fibroids (Stewart 2001). These symptoms vary from anaemia to menorrhagia, dysmenorrhoea, pressure symptoms, urinary frequency, even infertility and recurrent miscarriage. Th
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