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Abdominal Myomectomy

The following is a project I did in graduate school to create a web site for a health-related issue. Most of the information was taken from Fertility and Sterility

‘‘The restoration and maintenance of physiologic function is, or should be, the ultimate goal of surgical treatment,’’ said Bonney, an early advocate of abdominal myomectomy, in 1931 (52). However, women may be informed that myomectomy (fibroid removal) is not appropriate because hysterectomy is safer or is associated with less blood loss or because sarcoma may be present. Recent reports do not support these concerns (53–55).

Myomectomy even may be considered for women with large uterine fibroids who desire to retain their uterus. A study of 91 women with uterine size of >16 weeks (range, 16–36 wk) reported no conversions to hysterectomy. Complications included one bowel injury, one bladder injury, and one reoperation for incarcerated bowel. With use of a cell saver in 70 women, only 7 required homologous blood transfusion (56). A retrospective cohort study compared the morbidity of abdominal hysterectomy in 89 women who had fibroids with that of 103 women who had abdominal myomectomy (57). Unfortunately, the study was not adjusted for uterine size (in the hysterectomy group, 15.2 wk vs. in the myomectomy group, 11.5 wk), and selection bias was likely. Nevertheless, there were no visceral injuries in the myomectomy group, but the hysterectomy group developed two ureteral, one bladder, one bowel, and one nerve injury, and in that group, there were two reoperations for bowel obstruction.

Case–controlled studies suggest that there may be less risk of intraoperative injury with myomectomy when compared with hysterectomy. A retrospective review of 197 women who had myomectomies and 197 women who had similar uterine size and underwent hysterectomies (14.4 vs. 15.6 wk) found that operating times were longer in the myomectomy group (200 vs. 175 min), but estimated blood loss was greater in the hysterectomy group (227 vs. 484 mL) (55). The risks of hemorrhage, febrile morbidity, unintended surgical procedure, life-threatening events, and rehospitalization were no different between groups. However, 26 (13%) of the women in the hysterectomy group developed complications, including 1 who incurred a cystotomy, 1 who incurred ureteral injury, 3 who incurred bowel injuries, 8 who developed ileus, and 6 who developed pelvic abscesses. In contrast, complications occurred in 11 (5%) of the myomectomy patients, including 1 who had a cystotomy, 2 who had a reoperation for small bowel obstruction, and 6 who developed ileus. The investigators concluded that after logistic regression analysis, no clinically significant difference in perioperative morbidity was detected, and myomectomy should be considered as a safe alternative to hysterectomy. Robotic myomectomy was not studied.