Reoperation rates for recurrence of fibroids after abdominal myomectomy in women with large uterus

Abstract

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 surgery. Timing between surgeries correlated with age at initial surgery and uterine size but race, number of fibroids, aggregate weight of fibroids removed, operative time or blood loss at the initial surgery did not correlate. Data is suggestive that intraperitoneal triamcinolone may reduce reoperation rates but not timing of recurrence. Conclusion These results may help in counseling patients, particularly younger women, on the risks of fibroid recurrence necessitating repeat surgery. Further research is necessary to assess if triamcinolone can alter fibroid reurrence in patients who undergo uterus sparing procedures.

Long-Term Risk of Reintervention After Surgical Leiomyoma Treatment in an Integrated Health Care System

“…Few previous studies have evaluated racial and ethnic variation in risk of reintervention, and findings are mixed, with one study reporting 12–21% lower odds for Black compared with White patients, 12 another reporting 13% higher odds (but with a wide CI), 6 and a third reporting no relationship between race and reoperation. 13 Black women experience earlier onset and greater leiomyoma prevalence, 14 greater leiomyoma growth, and more severe symptoms than White women, 10 so it is unexpected that reintervention rates were not elevated for Black patients. Reintervention is a crude measure of recurrent or persistent symptoms after uterus-preserving treatment; it is possible that Black, Hispanic, and Asian patients experiencing symptoms may be less likely than White patients to seek surgical reintervention because of mistrust of or frustration with the medical system, 15 , 16 cost barriers, 17 desire to avoid hysterectomy, 18 or other reasons.…”

Surgical and Fertility Outcomes of Reduced-Port Robotic Myomectomy: A Single-Center Experience of 401 Cases

“…We reported a symptomatic recurrence rate of 14.7%, with a median of 3.1 cm. One study reported that reoperation rates after abdominal myomectomy were 12%, and our rates with robotic myomectomy were 7.4% [ 32 ]. We speculate that our recurrence data may have been over-estimated with selection bias, as those with recurrence of myomas after the operation were continuously followed up.…”

Evidence-Based Approach for Secondary Prevention of Uterine Fibroids (The ESCAPE Approach)

“…UF recurrence is a common concern after surgical removal or other treatment interventions [165]. EGCG, with these great properties, collectively contributes to inhibit UF growth and recurrence by targeting key pathways involved in UF development and progression [93,166].…”