Objective: The purpose of this study of 109 myomectomies is to evaluate the feasibility, limits and results in term of fertility of the laparoscopic myomectomy.
Material And Methods: Retrospective study from January 1990 to December 1993, including 109 patients having had a myomectomy, 39 by laparotomy (35,7%) and 70 by laparoscopy.
Results: The average number of myomas extracted by laparoscopy and by laparotomy were 1.5 and 6.7 respectively. The diameter of the major myoma was 7 cm in the laparotomic group versus 6.2 cm in the laparoscopic group. Among 70 myomectomies approached by laparoscopy, 29 (41,4%) have necessitated a laparoconversion. The reason of this conversion was mainly the size of the myoma (superior 5 cm) in 21 cases, the number of myomas (superior 5) in 6 cases, the interstitiel location of the myoma in 1 case and a per-operative hemorrhage in 1 case. Among 109 patients having had a myomectomy, 60 (55%) desired a pregnancy including 22 patients having laparoscopy myomectomy. Among these 22 patients, 8 have been pregnant (36.4%) allowing 9 pregnancies (4 deliveries, 4 missed abortions and 1 intrauterin fetal death).
Conclusion: Our results confirm that the laparoscopic myomectomy would have to be reserved to patients presenting to the most 4 myomas with a diameter < or = 7 cm. Results in term of fertility of the laparoscopic myomectomy are similar to these of patients having a laparoconversion.
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