Our Summary

This study looked at changes in the way a certain type of surgery, called a myomectomy, is performed and how this might be linked to an increase in a serious complication known as uterine rupture. Myomectomy is a procedure that removes fibroids (non-cancerous growths) from the uterus. It can be done in two ways: via laparotomy (open surgery) or laparoscopy (keyhole surgery).

The researchers looked at the medical records of women aged 18-40 who had a myomectomy between 2005 and 2014. They recorded how many of these women experienced a uterine rupture afterwards.

They found that out of over 54,000 myomectomies performed, 237 resulted in a uterine rupture. This is a rate of less than half a percent. Most of the women were around 32 years old, Caucasian, and had private health insurance. The majority of the procedures were performed via laparotomy.

The total number of myomectomies performed decreased between 2005 and 2014. However, the rate of uterine rupture was higher for those who had the procedure done by laparoscopy compared to laparotomy.

In conclusion, the trend towards using laparotomy over laparoscopy in recent years might be linked to a lower risk of uterine rupture. This suggests that laparoscopic myomectomy may be more likely to result in uterine rupture compared to the open approach.

FAQs

  1. What is the rate of uterine rupture after a myomectomy according to the study?
  2. Has there been a change in the preferred method of myomectomy over the years?
  3. Does the method of myomectomy (laparoscopy or laparotomy) affect the risk of uterine rupture?

Doctor’s Tip

A helpful tip a doctor might tell a patient about myomectomy is to discuss with their healthcare provider the best surgical approach for their individual case, as the risk of uterine rupture may vary depending on whether the myomectomy is performed by laparoscopy or laparotomy. It is important for the patient to understand the potential risks and benefits of each approach in order to make an informed decision about their treatment.

Suitable For

Patients who are typically recommended myomectomy are women aged 18-40 years who have symptomatic fibroids causing heavy menstrual bleeding, pelvic pain, and pressure symptoms. These women may have completed childbearing or desire future fertility preservation. Patients with large fibroids causing significant distortion of the uterine cavity or those with failed medical management of their symptoms may also be candidates for myomectomy.

Timeline

Before myomectomy:

  • Patient experiences symptoms of uterine fibroids such as heavy menstrual bleeding, pelvic pain, and pressure
  • Consultation with a gynecologist to discuss treatment options, including myomectomy
  • Pre-operative testing and preparation for surgery, including blood work and imaging studies
  • Consent for surgery and discussion of potential risks and benefits

After myomectomy:

  • Recovery period in the hospital or at home, depending on the type of surgery (laparoscopy or laparotomy)
  • Follow-up appointments with the gynecologist to monitor recovery and address any concerns
  • Relief from symptoms of uterine fibroids, such as improved menstrual bleeding and pelvic pain
  • Potential for future pregnancy, as myomectomy can preserve fertility in some cases

Overall, myomectomy is a safe and effective surgical option for women experiencing symptoms of uterine fibroids, with a low risk of complications such as uterine rupture.

What to Ask Your Doctor

  1. What are the different types of myomectomy procedures available and which one do you recommend for my specific case?
  2. What are the potential risks and complications associated with myomectomy, including the risk of uterine rupture?
  3. How many myomectomies have you performed, and what is your experience with preventing and managing uterine ruptures during the procedure?
  4. How will my recovery process differ depending on whether I undergo a laparoscopic or laparotomy myomectomy?
  5. What steps can I take to reduce my risk of uterine rupture after myomectomy?
  6. How often will I need follow-up appointments to monitor my recovery and any potential complications, including uterine rupture?
  7. Are there any alternative treatment options to myomectomy that may be safer for me in terms of uterine rupture risk?
  8. What signs or symptoms should I watch out for that may indicate a uterine rupture after myomectomy, and when should I seek immediate medical attention?
  9. Are there any lifestyle changes or precautions I should take after myomectomy to reduce my risk of uterine rupture in the future?
  10. Can you provide me with any additional resources or information about uterine rupture and its relationship to myomectomy?

Reference

Authors: Gil Y, Badeghiesh A, Suarthana E, Mansour F, Capmas P, Volodarsky-Perel A, Tulandi T. Journal: J Gynecol Obstet Hum Reprod. 2020 Oct;49(8):101843. doi: 10.1016/j.jogoh.2020.101843. Epub 2020 Jun 22. PMID: 32585390