ABDOMINAL MYOMECTOMY AND ITS MORBIDITY
Background: Abdominal myomectomy has classically been viewed as a procedure associated with high intra operative and postoperative morbidity. This study was designed to review the experience with abdominal myomectomy and to assess morbidity associated with the procedure. Methodology: This study was conducted at Azad Jammu & Kashmir Medical College, Muzaffarabad. The hospital records of 116 women who underwent abdominal myomectomies from January 2012 to December 2016 were reviewed retrospectively. Particular attention was paid to blood loss and the febrile conditions. Blood loss was reckoned from surgeonsâ€™ operative notes. It was calculated by subtracting total irrigation fluid used from the total amount of fluid in the suction, the suction container at the end of surgery, then adding the amount of blood on the sponges, determined by weight. Ethical approval for article was obtained from Hospital Ethical Committee. The data collected was analyzed using SPSS-17. Chi-square test was applied and p<0.05 was taken as statistically significant. Results: The mean estimated intraoperative blood loss was (320Â±25 ml). Three (2.6%) had an estimated blood loss >1,000 ml and 1 (0.9%) had estimated blood loss of >1,500 ml. Febrile morbidity occurred in 26 (22.5%) patients, wound infection in 6 (5.3%), haemorrhage in 3 (2.7%) patients, and postoperative antibiotics were used in 66 (56.9%) cases. There was no re-admission and no mortality associated with the procedure. Conclusion: Myomectomy may be an attractive alternative to hysterectomy in selected women with uterine leiomyomata, with an added advantage of preservation of womenâ€™s sexual and reproductive functions. Women with very large uterine size should not be denied this procedure for safety concerns.
Keywords: Abdominal myomectomy, blood loss, transfusion, pyrexia, morbidity, mortality, women
Pak J Physiol 2018;14(1):30â€“2
2. Buttram VC Jr. Uterine leiomyomata--Aetiology, symptomatology and management. Prog Clin Biol Res 1986;225:275â€“96.
3. Stewart EA. Uterine fibroids. Lancet 2001;357:293â€“298.
4. Wallach EE. Myomectomy. In: Thompson JD, Rock JA, (eds.) Te Lindeâ€™s operative gynaecology. 7th ed. Philadelphia: Lippincott; 1992. p.47â€“62.
5. Wallach EE. Evaluation and management of uterine causes of infertility. Clin Obstet Gynecol 1979;22:43â€“60.
6. Smith DC, Uhlir JK. Myomectomy as a reproductive procedure. Am J Obstet Gynecol 1990;162:1476â€“82.
7. Rosenfeld DL. Abdominal myomectomy for otherwise unexplained infertility. Fertil Steril 1986;46:328â€“30.
8. Starks GC. CO2 laser myomectomy in an infertile population. J Reprod Med 1988;33:184â€“6.
9. ACOG. Quality assessment and improvement in Obstetrics and Gynaecology. Washington DC: American College of Obstetricians and Gynecologists;1995.
10. Marchionni M, Fambrini M, Zambelli V, Scarselli G, Susini T. Reproductive performance before and after abdominal myomectomy: a retrospective analysis. Fertil Steril 2004;82:154â€“9.
11. Wallach EE, Vlahos NF. Uterine myomas : an overview of development, clinical features and management. Obstet Gynecol 2004;104:393â€“406.
12. Mohammed NB, NoorAli R, AnandKumar C. Uterine fibroid: Clinical presentation and relative morbidity of abdominal myomectomy and total abdominal hysterectomy in a teaching hospital of Karachi. Singapore Med J 2002;43(6):285â€“95.
13. Frederick J, Fletcher H, Simeon D, Mullings A, Hardie M. Intramyometrial vasopressin as a haemostatic agent during myomectomy. Br J Obstet Gynaecol 1994;101:435â€“7.
14. Celik H, Sapmaz E. Use of a single preoperative dose of misoprostol is efficacious for patients who undergo abdominal myomectomy. Fertil Steril 2003;79:1207â€“10.
15. Dai Y, Shu Q. Carbetocin and Carboprast tromethamine compare the role of prevention of postpartum hemorrhage. Chin Clin Med 2009;6(3):424â€“5.
16. Xie P. Carbetocin prevention of postpartum hemorrhage study. Chin J Pract Med 2010;5(18):34â€“5.
17. Chong YS, Su LL, Arulkumaran S. Current Strategies for the prevention of postpartum hemorrhage in the third stage of labour. Curr Opin Obstet Gynecol 2004;16(2):143â€“50.
18. Kongnyuy E, Wiysonge C. Interventions to reduce haemorrhage during myomectomy for fibroids. Cochrane Database Syst Rer 2007;(1):CD 005355.
19. LaMorte AI, Lalwani S, Diamond MP. Morbidity associated with abdominal myomectomy. Obstet Gynecol 1993;82:897â€“900.
20. Gambone JC, Reiter RC, Lench JB. Quality assurance indicators and short term outcome of hysterectomy. Obstet Gynecol 1990;76(5 Pt 1):841â€“5.
21. Rybak EA, Polotsky AJ, Woreta T, Hailpern SM, Bristow RE. et al. Explained compared with unexplained fever in postoperative myomectomy and hysterectomy patients. Obstet Gynecol 2008;111:1137â€“42.
22. Toglia MR, Pearlman MD. Pelvic fluid collections following hysterectomy and their relation to febrile morbidity. Obstet Gynecol 1994;83(5 Pt 1):766â€“80.
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