Myomectomy for uterine preservation and fertility

Abstract

Background: Leiomyomas are benign monoclonal smooth muscle tumors that are characterized by cellular mutations, growth factor dysfunction, and abnormalities in the extracellular matrix. The objective of this study was to analyse the patient selection, feasibility, complications and the outcomes of myomectomies done for uterine preservation and fertility.Methods: Out of 606 myomectomies performed over 23 years at a tertiary care endoscopy centre, retrospective analysis of 358 cases of laparoscopic myomectomy (LM) and 96 cases of abdominal myomectomy (AM) was done.Results: Myomectomies were done for symptomatic women who wanted to preserve their uterus either to improve fertility or pregnancy outcome. Sizes of myomas tackled by myomectomy ranged from 1 cm to 20 cms. The largest number removed by laparoscopy was 19. 9 out of 358 cases scheduled for LM were converted to AM. 6 patients had repeat myomectomy of myomas. About 0.44% had STUMP and 0.44% had leiomyosarcoma on HPE. Only 10/199 or 5% of patients who wanted to preserve their uterus had subsequent hysterectomies. 95% were satisfied with good symptom relief. 40.1% in LM and 37% in AM group conceived.Conclusions: Majority of the cases were successfully done by laparoscopy. With increasing experience more cases with bigger and multiple myomas could be tackled by laparoscopy. 10.3% in LM and 45.9% in AM were 10 cms-20 cms. The main method of retrieval was morcellation. There were no major complications. Both the methods were found to be safe, feasible and provided good result. With increasing experience bigger and multiple myomas could be tacked by LM, which has several advantages over AM.