Feasibility of myomectomy performed by minilaparotomy.

BACKGROUND: To evaluate feasibility and clinical outcomes of myomectomy performed through minilaparotomic access in a large series of consecutive patients. METHODS: All patients submitted to laparotomic conservative surgery for uterine myomas through an initial minilaparotomic approach (4-8-cm transverse skin incision) were retrospectively evaluated. Preoperative findings, surgical technique, rate of laparotomic enlargement, operative time, surgical complications and length of recovery were the main analyzed outcomes. RESULTS: One hundred and seventy out of 212 patients experienced minilaparotomic approach for uterine myomatosis. In 97 (57.1%) multiple myomas were present (maximum, 23). The size of the largest myoma ranged from 2 to 19 cm (median 5.6). In 161 (94.7%) patients myomectomy was ended through minilaparotomic access with a mean length of skin incision of 6.2 cm (4-7.8). The correlation between severe obesity and laparotomic enlargement was statistically significant (p<0.05). The mean operative time was 57 min (32-118). One bladder intraoperative injury was successfully managed through minilaparotomic incision. Bowel or vascular complications never occurred. Estimated blood loss was not significant except in three cases (1.9%) requiring transfusion. Febrile complications were observed in nine patients (5.6%). The median postoperative stay in uncomplicated patients was 2.5 days (2-4). CONCLUSIONS: Our report supports the wide application of minilaparotomic myomectomy and suggests that more than 85% of women with fit uterine myomatosis could be successfully managed in this way with a failure rate of 5.3% in eligible patients. The main criteria of minimal invasive surgery seem to be by minilaparotomic myomectomy, which should be considered a valid option for uterine myohas conservative treatment.

Reproductive performance before and after abdominal myomectomy: a retrospective analysis.

OBJECTIVE: To evaluate the results of abdominal myomectomy for intramural and subserosal fibroids and to identify factors that influence the reproductive outcome after surgery. DESIGN: Retrospective analysis of a case series. SETTING: An academic department specializing in gynecologic surgery. PATIENT(S): A total of 72 women with intramural and subserosal fibroids submitted to abdominal myomectomy who wished to conceive after surgery. INTERVENTION(S): Data were collected on clinical characteristics, surgical features, and obstetric history before and after surgery. MAIN OUTCOME MEASURE(S): Conception rate, pregnancy loss, and live birth rate before and after surgery, as well as postoperative probability of conception according to selected clinical and fibroid characteristics. RESULT(S): Conception rate was 28% before myomectomy and 70% after surgery. The corresponding figures were 69% and 25% for pregnancy loss and 30% and 75% for live birth rate, respectively. Age <30 years and number of fibroids removed were the only significant and independent predictors of obstetric outcome by multivariate analysis. CONCLUSION(S): Our results suggest that abdominal myomectomy might improve reproductive outcome in patients with intramural and subserosal fibroids. The reproductive performance was particularly good when the patients were younger than 30 years and had a single myoma to remove.