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Myomectomy: technique and current indications. | LitMetric

Myomectomy: technique and current indications.

Minerva Ginecol

Department of Obstetrics and Gynecology, University Hospital Pellegrin, Bordeaux, France -

Published: August 2017

AI Article Synopsis

  • * Myomectomy, a surgical option to remove fibroids, is preferred for those wanting to maintain fertility, but its effectiveness on reproductive outcomes is debated.
  • * The paper reviews surgical techniques for myomectomy and highlights that while it can help with symptoms and certain infertility cases, only removing submucosal fibroids consistently enhances fertility.

Article Abstract

Uterine fibroids are the commonest benign tumor of the female genital tract. They affect a significant proportion of reproductive aged women and may cause excessive menstrual bleeding, pelvic pain or pressure, and adversely affect reproductive outcomes. However, many women remain asymptomatic. Fibroids are the first indication for hysterectomy, but myomectomy is the most suitable surgical option for women who desire preservation of their fertility potential. Only a selected group of women of childbearing age will benefit from a myomectomy, as the consequences of myomectomy on reproductive function have remained controversial. The purpose of this paper was to review the main surgical approaches for myomectomy, and discuss evidence-based indications for myomectomy in women with fibroids, especially with regards to its impact on fertility and reproductive outcomes. A critical review of the literature pertaining to the surgical approaches of myomectomy and the indications for myomectomy was performed, focusing on their impact on fertility and reproductive outcomes. Myomectomy is useful for the treatment of symptomatic fibroids and in selected women with infertility. Symptomatic submucosal fibroids are classically treated by hysteroscopic resection. Symptomatic intramural and subserosal fibroids may be treated by myomectomy, either by laparotomy or laparoscopy depending on their number and size. Prophylactic myomectomy is not recommended for preventing obstetrical complications or the risk of leiomyosarcoma. Although fibroids may have a negative effect on fertility, only the removal of submucosal fibroids has been consistently shown to improve spontaneous fertility or outcomes of assisted reproduction technology.

Download full-text PDF

Source
http://dx.doi.org/10.23736/S0026-4784.17.04073-4DOI Listing

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