Myomectomy at the Chelsea Hospital for Women

Abstract

Out of 180 patients who had a myomectomy at the Chelsea Hospital for Women between 1954 and 1962, 116 were followed for more than one year. One in four of these patients had a subsequent hysterectomy and about one in three conceived after surgery. Of the patients known to have conceived only three out of four carried pregnancies beyond 28 weeks. Myomectomy did not seem to alter the high incidence of abortions and perinatal deaths in patients found to have fibromyomata. Pregnancies occurring after myomectomy required close specialist supervision and often ended in Caesarean section.

Risk of recurrence after myomectomy

“…Published studies show marked differences in the probability of recurrence after myomectomy (Table 3). Early reports generally showed rates around 5 to 10% (Berkeley et al 1983; Bonney 1931; Brown et al 1956; Conseller & Bedard 1938) but, more recently, recurrence rates of 25–35% have been observed (Finn & Muller 1950; Loeffler & Noble 1970; Malone 1969), in agreement with the results of our research. These differences can be at least partly explained by the criteria for diagnosis of recurrence (ultrasonography is more sensitive than clinical assessment) and by deficiencies in long‐term follow‐up.…”

Reproductive outcome after laparoscopic myomectomy for intramural myomas in infertile women with or without associated infertility factors

“…Myomectomy is a challenging procedure because it involves the reconstruction of an organ that can undergo remarkable structural changes, as it does during pregnancy. The literature documents the normal reproductive performance of uteri after laparotomic myomectomy 19–21 . In the present study, the cumulative pregnancy rate for spontaneous intrauterine pregnancy was 50.0% 2 years after laparoscopic myomectomy for large intramural myoma.…”

Reproductive Uterine Surgery

“…In addition, many series report pregnancy rates of 35 to 50% subsequent to myomectomy in unselected patients, implying that the myomata were the cause of the infertility. [39][40][41][42]54 Some series [55][56][57][58][59] report similar results for those patients whose indication for surgery was solely infertility. My own work 60 suggests that a careful search must be made for other fertility-compromising factors before infertility is attributed solely to myomata and subsequent pregnancy to their removal.…”

“…Because of their recurrent nature, and because it is not always possible to remove all myomata at the time of surgery, reoperation is often necessary in the form of another myomectomy or hysterectomy. The rate for subsequent surgery ranges from 5 to 45% [40][41][42][55][56][57][58][59][60][61] Not all hysterectomies are performed for recurrent myomata. Malone 69 found that patients with multiple myomata were more likely to require future definitive surgery, and were less likely to conceive and carry to term than those patients with a single myoma.…”

“…The routine use of cesarean section is probably not indicated following myomectomy. In the ab- 41 Davids 40 Brown et al 55 Ingersoll 42 Brown et al 57 Loeffler, Noble 56 Babaknia et al 58 Berkeley sence of infection, healing of the uterine incision line is strong; Davids 40 reported no cases of uterine rupture in his series of 1150 myomectomies, almost all those of who became pregnant being delivered vaginally. Brown 57 reports 7 patients with cavity entry during myomectomy who subsequently conceived; 5 were delivered vaginally.…”