Operative morbidity and reproductive outcome in secondary myomectomy: a prospective cohort study (original) (raw)
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Journal of Obstetrics and Gynaecology, 2019
This was a retrospective cohort study evaluating peri-operative morbidity of 66 women who underwent repeat abdominal myomectomy compared with 200 women who had primary myomectomy in the same period, matched for age and uterine size. We report the reproductive outcome of women seeking fertility after repeat myomectomy. More pre-operative GnRH analogues were used and midline abdominal skin incision performed in the repeat myomectomy group. The likelihood of major complication was three times higher in the repeat abdominal myomectomy group (OR 3.0, 95% CI 1.67-5.5, p < .001). There was a significantly longer mean hospital stay (p < .01), higher incidence of bleeding (p < .01) and urinary or wound infection (p < .01) in the repeat abdominal myomectomy group. Of the 47 women who had repeat myomectomy for fertility reasons, six women conceived and two live birth at term (4%). Our study highlights the significant peri-operative morbidity and poor subsequent live birth rate associated with repeat abdominal myomectomy. IMPACT STATEMENT What is already known on this subject? Repeat abdominal myomectomy is a major surgical procedure with significant morbidity. However, abdominal myomectomy for large fibroid uterus remains the preferred treatment method for women who wish to preserve fertility. Sufficient evidence related to the peri-operative morbidity and fertility outcome after repeat abdominal myomectomy is lacking. What do the results of this study add? This is the largest study reporting peri-operative morbidity and pregnancy outcome following repeat abdominal myomectomy. Our results highlight the three times increased risk of major complications associated with repeat abdominal myomectomy compared to primary myomectomy with the poor subsequent live birth rate. What are the implications of these findings for clinical practice and/or further research? Our study complements the sparse existing data on the outcome of repeat abdominal myomectomy and underscore the potentially significant peri-operative morbidity and poor subsequent live birth rate associated with the procedure. This information should be used in counselling women with fibroid recurrence after primary myomectomy before they embark on repeat surgery.
EC Gynaecology, 2021
Background: Symptomatic uterine fibroids are frequently encountered in gynecological practice in black populations. Its removal is associated with some complications and to control the occurrence of these, requires an understanding of the associated factors. Objective: This study sought to determine the rate and trend, indications, outcome and determinants of complications of open abdominal myomectomy in a tertiary hospital. Methodology: This was a retrospective review of open abdominal myomectomies performed between April 2015 to March 2020. Data were obtained from operating theater and gynecological ward records. Continuous variables were analyzed using Student's t-test and categorical variables were analyzed with chi-square test or Fisher's exact test. Multiple regression was used to test for significant associations with P < 0.05 as significant. Results: There were 1557 gynecological surgeries during the study period of which 374 (24%) were abdominal myomectomy, with an increasing trend from 20% in 2015 to 34.1% in 2019. Majority 219 (58.6%) were in the age category of 30-39 years and were nulliparous 298 (79.7%). The commonest indication was menorrhagia 294 (78.6%). Majority 286 (76.5%) had blood loss of < 500mls and 197 (52.7%) had duration of surgery of 120-180mins. The commonest complications were blood transfusion 88 (23.5%), Anemia 52 (13.9%) and wound sepsis 29 (7.8%). Hysterectomy for uncontrollable bleeding occurred in 8 (2.1%) of the women, there was no death recorded. Hemorrhage (blood loss), duration of surgery and indication for surgery were significantly related to the occurrence of complications on bivariate analysis, but following logistic regression, only hemorrhage remained significant. Conclusion: About a quarter of all gynecological surgeries performed were open abdominal myomectomy, with a rising trend. The outcome in this study was generally favorable and hemorrhage (blood loss) was significantly associated with the occurrence of most complication. Measures should be taken to reduce blood loss at surgery and patients should be counseled preoperatively on the risk of blood loss and the possibility of blood transfusion.
Myomectomy: a retrospective study to examine reproductive performance before and after surgery
Human Reproduction, 1999
The aim of this retrospective study was to establish the impact of myomectomy on pregnancy outcome with particular reference to its effect on the incidence of pregnancy loss. Myomectomy was performed using microsurgical procedures upon 51 women who had intramural or subserosal fibroids and wished to conceive. Overall, the conception rate following myomectomy was 57%. Multiple regression analysis showed that age was the only factor which influenced conception rate: ഛ35 years, 74% (23/31); ജ36 years, 30% (6/20; P Ͻ 0.005). The pregnancy loss rate prior to myomectomy was 60% (24/40), which was reduced to 24% (8/33) after myomectomy (P Ͻ 0.001). There was no instance of premature labour or scar rupture among 25 live births. This retrospective study suggests that myomectomy for intramural and subserosal fibroids may significantly improve the reproductive performance of women presenting with infertility or pregnancy loss.
Objective: To assess the effectiveness and safety of interventions to reduce blood loss during myomectomy. Methods: Electronic searches of the Cochrane Library, MEDLINE, and EMBASE, between 1966 and 2006 for randomized controlled trials (RCTs). Results: We found significant reductions in blood loss with vaginal misoprostol (weighted mean difference [WMD] −149.00 mL, 95% confidence interval [CI] −229.24 to −68.76); intramyometrial vasopressin and analogues (WMD −298.72 mL, 95% CI −593.10 to −4.34); intramyometrial bupivacaine plus epinephrine (WMD −68.60 mL, 95% CI −93.69 to −43.51); and pericervical tourniquet (WMD −1870.00 mL, 95% CI −2547.16 to −1192.84). There was no evidence of effect in blood loss with myoma enucleation by morcellation and oxytocin. Conclusion: There is limited evidence from a few RCTs that some interventions may reduce bleeding during myomectomy. There is need for adequately powered RCTs to shed more light on the effectiveness, safety, and cost of different interventions to reduce blood loss during myomectomy.
Reoperation rates for recurrence of fibroids after abdominal myomectomy in women with large uterus
PLoS ONE, 2021
Background The population of women undergoing abdominal myomectomy for symptomatic large fibroid uterus is unique. We seek to characterize the timing, risk factors as well as the presenting symptoms which led patients to undergo repeat surgery in this patient population. Methods and findings We followed 592 patients who underwent an abdominal myomectomy from March 1998 to June 2010 at St. Vincent’s Catholic Medical Center and presented later during the study period with a recurrence of symptoms attributable to a reemergence of fibroids and who chose to undergo repeat surgical management. Twelve percent of patients exhibited symptoms of fibroid uterus which led to reoperation within the study period. The mean age at repeat surgery was 44.1 ± 0.6 years old (n = 69) and the mean time between operations was 7.9 ± 0.3 years. Presentation was variable but included bleeding, pain and infertility. Patients presented for surgery with a significantly smaller sized uterus than at their initial...
Fertility and Sterility, 2004
To evaluate the therapeutic results of premyomectomy uterine depletion for the treatment of symptomatic fibroids, compared with myomectomy only. Design: Controlled, clinical study without randomization. Setting: University-affiliated tertiary referral center. Patient(s): Four hundred eighty-six women with symptomatic fibroids warranting surgical treatment and who wished to retain their uteri. Intervention(s): Ligation of the uterine arteries was performed by either an abdominal or a laparoscopic approach before myomectomy. Main Outcome Measure(s): Operation time, intraoperative blood loss, postoperative improvement of symptoms, and recurrence rates of fibroids.
Cesarean myomectomy for solitary uterine fibroids: Is it a safe procedure?
Polish Gynaecology, 2016
Objectives: Myomectomy during cesarean is still controversial. Our aim is to assess the safety and feasibility of myomectomy during cesarean section for solitary uterine fibroids in terms of intraoperative and postoperative risks. Material and methods Data from 306 patients with leiomyoma undergoing elective cesarean operations were reviewed retrospectively. Eighty-two patients who underwent myomectomy during cesarean section were compared to 224 patients diagnosed with myoma who did not undergo myomectomy. The patients were reviewed for pre-and post-operative hemoglobin values, duration of operation, amount of intraoperative hemorrhage, need for blood transfusion, and duration of hospital stay. Results: The decrease in hemoglobin values after operation was not significantly different between the groups (1.48±0.7 vs. 1.31±0.68 g/dL; p = 0.063). Both the hospital stay and operation durations were significantly longer in the myomectomy group (57.9±19.7 vs. 50.54±20.77 hours, p = 0.006; 39.94±12.5 vs. 35.27±9.1 minutes, p=0.001, respectively). The operation duration was significantly shorter in the group with myomas = 3 cm in size (35.41±9.33 vs. 45.58±16.57 vs. 47.05±10.61 minutes; p < 0.05). Conclusions: Cesarean myomectomy did not increase intrapartum or early postpartum morbidity. Thus, we suggest that myomectomy can be performed during cesarean section in selected patients to avoid repeat operations and additional cost.
Journal of Clinical Medicine, 2023
Background: The incidence of pregnant women with uterine fibroids is increasing. As they are reactive to hormonal stimuli, in some cases, uterine fibroids tend to grow during pregnancy and potentially generate symptoms with different levels of severity, causing maternal-fetal complications. In very select cases, when other treatment strategies fail to manage symptoms and there is a substantial risk of adverse pregnancy outcomes, a surgical approach during pregnancy may be considered. Methods: From 2016 to 2021, the data from 28 pregnant women with symptomatic uterine fibroids who underwent laparotomic myomectomy during pregnancy were prospectively collected, and operative and maternal-fetal outcomes were analyzed (ClinicalTrial ID: NCT06009562). Results: The procedure was carried out between 14 and 16 weeks of pregnancy. Four (14.3%) patients had intraoperative complications (miscarriages) and nine (32.1%) had postoperative complications (threatened preterm birth). Overall, 24 (85.7%) women delivered at full term (mean: 38.2 gestational weeks), more than half (n = 13; 54.2%) by vaginal delivery, with normal fetal weights and 1 and 5 min Apgar scores. Conclusions: Laparotomic myomectomy during pregnancy can be considered in selected cases for uterine fibroids with severe symptoms when other treatment options have failed and there is high risk of adverse maternal-fetal outcomes.
Laparoscopic myomectomy versus open myomectomy in uterine fibroid treatment: A meta-analysis
Laparoscopic, Endoscopic and Robotic Surgery, 2021
Objective: Uterine fibroids are the most commonly occurring benign solid tumors in women, and laparoscopic or open myomectomy constitutes the primary option for treatment. However, both methods are under debate currently in terms of efficacy and safety. In this meta-analysis we assessed the efficacy and safety of the two procedures. Methods: A comprehensive literature search of PubMed, ScienceDirect, and the Cochrane Library was conducted in December 2020. The search terms included "open myomectomy", "myomectomies", "laparoscopic", and "uterine fibroids". We then selected the randomized control trials published from 1996 to 2019 and compared laparoscopic and open myomectomies. Results: We included 10 studies of 449 patients who underwent laparoscopic myomectomy and 449 patients who underwent open myomectomy. The data revealed that laparoscopic myomectomy was associated with reduced blood loss (MD ¼ À34.43; 95% CI, À34.92 to À33.94; p < 0.00001), an attenuated decline in hemoglobin (MD ¼ À1.04; 95% CI, À1.14 to À0.93; p < 0.00001), less post-operative pain at 24 h (MD ¼ À0.51; 95% CI, À0.83 to À0.19; p ¼ 0.002), and fewer overall complications (OR ¼ 0.42; 95% CI, 0.24 to 0.71; p ¼ 0.001) relative to open myomectomy; but the former possessed a longer operative time (MD ¼ 12.96; 95% CI, 9.94 to 15.97; p < 0.00001). There were no significant differences in pregnancy rate (OR ¼ 1.39; 95% CI, 0.72 to 2.68; p ¼ 0.33) or recurrence rate of postoperative uterine fibroids (OR ¼ 1.15; 95% CI, 0.60 to 2.18; p ¼ 0.67) between the two groups. Conclusion: Laparoscopic myomectomy displayed superior results compared to open myomectomy, although the former involved a longer operating time.