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Surgical Treatment of Fibroids
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
Ibrahim Alkatout, Liselotte Mettler
Myomectomy is a surgical treatment option for women who have not completed their family or who wish to retain their uterus for any other reasons. The enucleation of fibroids by any method is an effective therapy for bleeding disorders or displacement pressure in the pelvis. Nevertheless, the risk of recurrence remains after myomectomy. Furthermore, if any other pathologies might be causative or only co-causative for the symptoms (such as adenomyosis uteri), these problems will persist (Wallach and Vlahos 2004). Complications arising at myoma enucleations and pregnancy-related complications have been investigated extensively. All operating possibilities, especially laparoscopic versus laparotomic but recently also laparoscopic versus robotic-assisted myomectomy, have been evaluated. Uterine rupture or uterine dehiscence is rare and occurs in less than 1% of laparoscopic cases and even less seldom in robotic-assisted and laparotomic cases. Careful patient selection and secure preparation and suture techniques appear to be the most important variables for myomectomy in women of reproductive age (Kim et al. 2013; Lonnerfors and Persson 2011). Uteri with multiple fibroids have an increased number of uterine arterioles and venules. Therefore, myomectomy can lead to significant blood loss and corresponding arrangements should be made (Mettler et al. 2012b).
Laparotomy for Surgical Treatment of Uterine Fibroids
Published in John C. Petrozza, Uterine Fibroids, 2020
Jeffrey M. Goldberg, Zaraq Khan
A substantially large number of women after abdominal myomectomy will have fibroids on subsequent evaluation; however, most will not require any additional treatment for fibroid-related symptoms. Approximately 27%–62% of women will have evidence of fibroids 5–10 years after myomectomy [26–28]. Younger women, those with multiple fibroids at time of myomectomy [29] and those who did not conceive after surgery [27] are more likely to have new or persistent lesions. Additionally, women who received preoperative gonadotropin-releasing hormone analogues (GnRH analogs) are more likely to have persistent fibroids after surgery. Risk factors for women requiring subsequent surgery for fibroid-related symptoms are not well studied. In one report, 34% of women needed a second surgery within 7 years of follow-up [30].
Hysteroscopic Myomectomy
Published in Botros R.M.B. Rizk, Yakoub Khalaf, Mostafa A. Borahay, Fibroids and Reproduction, 2020
Anja Frost, Mostafa A. Borahay
Topics to discuss with patients include intraoperative expectations as well as long-term risks. It is important to discuss risks of bleeding and infection, although the risk of both should be minimal with hysteroscopic myomectomy. The risk of uterine perforation and possible laparoscopy must be discussed and should be added to consent forms. Regarding long-term postoperative measures, it is important to counsel patients that there is both a risk of recurrence (discussed more later) as well as a risk of incomplete resolution of symptoms based on either the size and/or myometrial extension of their fibroids, or the possibility of additional/alternative pathologies playing a role in their abnormal uterine bleeding. If myomectomy is being performed for fertility reasons, it is important to counsel patients that it is rare for submucosal fibroids to be the sole cause of infertility and that this procedure may not return the patients to baseline fertility levels or ensure successful subsequent in vitro fertilization.
Long-term outcomes of ultrasound guided high intensity focused ultrasound ablation for patients with uterine fibroids classified by T2WI: a multicenter retrospective study
Published in International Journal of Hyperthermia, 2023
Yuan Yuan, Wei Xu, Huangpin Shen, Zhenjiang Lin, Fan Xu, Qiuling Shi, Ping Zhan, Mali Liu, Jian Shu, Jinyun Chen, H. Rosie Xing
For any uterine preserving treatment strategy for uterine fibroids, the follow-up outcomes are still a major clinical concern. Myomectomy is the first-line uterine sparing therapeutic strategy of symptomatic uterine fibroids. Xu et al. [14] have reported that the cumulative reoperation rate after myomectomy, UAE and magnetic resonance-guided HIFU (MRgHIFU) were 9%, 14% and 22% at three years and 19%, 21% and 49% at five years, respectively. Wang et al. [2] reported that the cumulative reoperation rate after myomectomy and USgHIFU were 11.9% and 3.2% at three years and 15.5% and 9.5% at five years, respectively. We found that about 80% of the patients with hypointense or isointense fibroids achieved complete symptom relief, and the cumulative reintervention rates at 44 months (median duration of follow-up) were only 8.8% and 10.8%, respectively. Previous studies have reported similar reintervention rates for hypointense and isointense fibroids after USgHIFU treatment and myomectomy [2,14]. The NPV ratio of the uterine fibroids is the most important factor affecting the clinical outcome of HIFU treatment, and an NPV ratio of at least 80% is associated with greater volume shrinkage and better follow-up outcomes [15,16]. In this study, the mean NPV ratios of hypointense and isointense fibroids were 89.0% and 86.6%, respectively, which lead to sustained fibroids volume reduction and have ensured favorable long-term outcomes. Therefore, hypointense and isointense fibroids are good indications for HIFU treatment.
Long-term risk of uterine malignancies in women with uterine fibroids confirmed by myomectomy: a population-based study
Published in Journal of Obstetrics and Gynaecology, 2022
This is the first report investigating the risk of uterine malignancy in women with uterine fibroids, confirmed by myomectomy, from a large database of 23 million patients per year. Based on data obtained from the Korean HIRA database for 2007–2020, the risk of uterine malignancy in women aged 20–50 years with uterine fibroids was 0.054% (46/84,507) and that in the control group was 0.043% (37/84,507). There was no statistically significant difference in the incidence rates between both groups (p = .323). Uterine fibroids don’t appear to be a risk factor for uterine malignancies, and tissue injury by myomectomy does not appear to cause malignant transformation. If surgery is indicated, myomectomy can be performed safely, given that the long-term risk of uterine malignancy does not increase.
High-intensity focused ultrasound (HIFU) for the treatment of uterine fibroids: does HIFU significantly increase the risk of pelvic adhesions?
Published in International Journal of Hyperthermia, 2020
Xiaofang Liu, Xiaojing Dong, Yan Mu, Guohua Huang, Jia He, Lina Hu
Uterine fibroids are the most common benign tumors in the reproductive system of reproductive women. Almost half of the patients present with heavy menstrual bleeding, lumbosacral pain, constipation, and other symptoms [3]. Currently, surgery is still the treatment of choice for uterine fibroids and myomectomy is one of the most common gynecological procedures. However, post-surgical adhesions are of great concern. One study showed that 93.7% of patients undergoing open myomectomy form pelvic adhesions [4]. Compared with open surgery, laparoscopy reduces peritoneal trauma and de novo adhesion formation; however, it may cause peritoneal inflammation due to pneumoperitoneum pressure and thermal injuries. Pelvic adhesions remain a major public health problem despite the development of laparoscopy [5].