Successful Removal of 68 Fibroids from A Uterus At Myomectomy: Case Report (original) (raw)
Related papers
The excision of uterine fibroids by vaginal myomectomy: a prospective study
Fertility and Sterility, 1999
Objective: To evaluate the clinical effectiveness and safety of the excision of uterine fibroids by vaginal myomectomy. Design: Prospective study. Setting: A gynecology department of a university teaching hospital. Patient(s): Women with menorrhagia, pelvic pain, symptoms of pressure, or subfertility attributable to moderate-sized uterine fibroids who otherwise would have required abdominal or laparoscopic myomectomy. Intervention(s): Vaginal myomectomy. Main Outcome Measure(s): The feasibility of vaginal surgery, operative complications, postoperative recovery, and relief of symptoms. Result(s): Myomectomy was completed vaginally in 32 (91.4%) of 35 patients and none required hysterectomy. The overall operating time was 78 minutes, the estimated operative blood loss was 313 mL, and the mean postoperative hospital stay was 4 days. Pelvic hematomas developed in 4 patients, and one colpotomy required resuture. Seventy-four percent of the women reported relief of their symptoms at 3 months' follow-up. Three patients have had full-term pregnancies since the operation. Conclusion(s): Myomectomy can be performed by the vaginal route in selected cases with low morbidity and a good short-term success rate. Unlike open myomectomy, it requires no skin incision, and unlike laparoscopic myomectomy, it can be used in patients who have numerous, relatively large, and intramural fibroids. (Fertil Steril 1999;71:961-4.
Abdominal Myomectomy For The Treatment Of Symptomatic Uterine Fibroids
Medical Science Journal for Advance Research
Background: Fibroids are common problem for women in elderly reproductive age. Aim: The present study aimed at assessing abdominal myomectomy for the treatment of symptomatic uterine fibroids. Methodology: The present retrospective study was conducted from 22 June 2020 to 23 July 2021 at Mayo Hospital, Lahore. Females undergone abdominal myomectomy with age 30 to 50 years were included. The primary and secondary outcomes were defined and assessed to evaluate the procedure. Results: The findings indicate that 32 (62.74%) of the patients showed successful outcome for menorrhagia. On the other hand, 27 (50.94%) patients showed successful outcome for pain and 30 (60%) showed for mass effect. Conclusion: Abdominal myomectomy is an ideally applicable procedure for the removal of fibroids.
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.
A Case Report of Multiple (29) Myomectomies
Juniper online journal of case studies, 2018
Fibroids uterus also called uterine leiomyoma are the most frequently encountered benign tumours of the uterus. Many fibroids are asymptomatic and are picked up on routine examination. Clinical features depend on number, size and location of the fibroids. Symptomatic fibroids may be managed medically or surgically. Hysterectomy by different routes is the commonest operation performed for fibroid uterus. Hysterectomy may not be the desired where uterus needs to be retained for different reasons. Removal of fibroids called myomectomy followed by reconstruction of uterus is the correct and desired mode of management in such cases. We report one such case where 29 fibroids of varying sizes were removed abdominally and uterus reconstructed in an unmarried girl who conceived spontaneously within one year of surgery after marriage. Vasopressin is effective in reducing the blood loss at the time of myomectomy. Mifepristone is a new mode of treating fibroids medically.
Gynecologic and Obstetric Investigation, 2006
Aim: To evaluate the recurrence rate of uterine fibroids (UF) after abdominal myomectomy and the risk factors for recurrences. Methods: In aretrospective study, transvaginal ultrasound examinations were performed in 135 women after abdominal myomectomy. The main outcome measures were cumulative UF recurrence rates after abdominal myomectomy. The Kaplan-Meier survival analysis was used to estimate the cumulative recurrence rate, and log-rank tests were applied to compare survival curves among different categorical groups of potential risk factors for recurrences. Results: The cumulative UF recurrence rates at 12 and 24 months after abdominal myomectomy were 12.4 and 46.0%, respectively. Women who had a history of previous myomectomy had a higher hazard of UF recurrence than women without such a history (hazard ratio 4.1, 95% confidence interval 1.20–13.6). The women having four or more UFs had a higher hazard than those who had less than four UFs (hazard ratio 3.7, confidence interva...
Journal of Obstetrics, Gynecology and Cancer Research , 2020
Background and Objective: Management of caesarean myomectomy (CM) in lower uterine segment obstruction is a hard process. Here I present a pregnant woman with multiple fibroid pregnancy and an obstructing intramural fibroid in the lower segment. The CM procedure was modified here with initially excision of obstructing myoma and delivery of baby. Case Presentation: A primigravida woman visited emergency room with abdominal pain at 22 week gestation, receiving antenatal care elsewhere. The emergency abdomen USG showed multiple fibroids in pregnancy with a huge obstructing fibroid in lower segment and a breech presentation with no anomalies. Comparing earlier USG reports exposed that the multiple fibroids were growing across the gestation weeks along the developing fetus. The mother was followed for watchful expectancy till 37 weeks gestation and delivery was planned as elective LSCS. Cesarean myomectomy was carried out through initial excision of lower uterine segment myoma to remove the obstruction, and then deliver the baby through the same incision. Conclusion: Here the cesarean myomectomy procedure was altered from a regular one, featuring preliminary myomectomy of uterine fibroid in the lower segment, and then delivering the baby and myomectomies again. The outcome was delivering a live baby with hemostasis in a case, with multiple and large fibroids.
European Journal of Radiology, 2012
Objective: To evaluate the feasibility and safety of combined uterine artery embolization (UAE) using embosphere and surgical myomectomy as an alternative to radical hysterectomy in premenopausal women with multiple fibroids. Materials and methods: Mid-term clinical outcome (mean, 25 months) of 12 premenopausal women (mean age, 38 years) with multiple and large symptomatic fibroids who desired to retain their uterus and who were treated using combined UAE and surgical myomectomy were retrospectively analyzed. In all women, UAE alone was contraindicated because of large (>10 cm) or subserosal or submucosal fibroids and myomectomy alone was contraindicated because of too many (>10) fibroids. Results: UAE and surgical myomectomy were successfully performed in all women. Myomectomy was performed using laparoscopy (n = 6), open laparotomy (n = 3), hysteroscopy (n = 2), or laparoscopy and hysteroscopy (n = 1). Mean serum hemoglobin level drop was 0.97 g/dL and no blood transfusion was needed. No immediate complications were observed and all women reported resumption of normal menses. During a mean follow-up period of 25 months (range, 14-37 months), complete resolution of initial symptoms along with decrease in uterine volume (mean, 48%) was observed in all women. No further hysterectomy was required in any woman. Conclusion: In premenopausal women with multiple fibroids, the two-step procedure is safe and effective alternative to radical hysterectomy, which allows preserving the uterus. Further prospective studies, however, should be done to determine the actual benefit of this combined approach on the incidence of subsequent pregnancies.
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...
Fibroids (uterine myomatosis, leiomyomas)
Clinical evidence, 2007
IntroductionBetween 5-77% of women may have fibroids, depending on the method of diagnosis used. Fibroids may be asymptomatic, or may present with menorrhagia, pain, infertility, or recurrent pregnancy loss. Risk factors for fibroids include obesity, having no children, and no long-term use of the oral contraceptive pill. Fibroids tend to shrink or fibrose after the menopause.Methods and outcomesWe conducted a systematic review and aimed to answer the following clinical questions: What are the effects of: medical treatment alone; preoperative medical treatments for women scheduled for surgery; and surgical treatments in women with fibroids? We searched: Medline, Embase, The Cochrane Library and other important databases up to November 2006 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). ResultsWe found 41 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.ConclusionsIn this systematic review we present information relating to the effectiveness and safety of the following interventions: gonadorelin analogues (with progestogen, raloxifene, tibolone, or combined oestrogen-progestogen); hysterectomy (plus oophorectomy); hysteroscopic resonance-focused ultrasound; laparoscopic myomectomy; laparoscopically assisted vaginal hysterectomy; rollerball endometrial ablation; thermal balloon ablation; thermal myolysis with laser; total abdominal hysterectomy; total abdominal myomectomy; total laparoscopic hysterectomy; total vaginal hysterectomy.