Indications and outcome of abdominal myomectomy in University of Maiduguri Teaching Hospital: Review of ten year

Abstract

Background:Abdominal myomectomy is a common modality of treatment for large and symptomatic uterine fibroid in women who wish to retain their fertility. Though frequently performed the procedure may still be associated with complications.Materials and Methods:A retrospective review of all patients who had abdominal myomectomy from January 1999 to December 2008 at the University of Maiduguri Teaching Hospital. Information on the Sociodemographic characteristics, indication for the myomectomy, uterine size, pre and post operative packed cell volume (PCV), intraoperative findings, cadre of surgeon, duration of hospital stay and complications were obtained.Results:The rate of abdominal myomectomy was 3.34%. Majority of the patients (79.8%) aged 30–49 years, and most (58.9%) were nulliparas. Abdominal mass (63.7%), menorrhagia (57.7%), and subfertility 55.2% were the leading indications for abdominal myomectomy. Complications were seen in 10.9% of the cases, 55.5 % of which were wound infections. Clinical and intra operative factors associated with complications included menorrhagia (P=0.003), estimated blood loss (EBL) ≥500mls (P=0.005) and post operative PCV of <30% (P=0.081).Conclusion:Complication rate after myomectomy was low with menorrhagia and EBL ≥ 500 mls being significantly associated with development of complication.

Abdominal myomectomy: A retrospective review of determinants and outcomes of complications at the University of Ilorin Teaching Hospital, Ilorin, Nigeria

“…Duration of surgery longer than 4 hours was significantly related to occurrence of complications (P = 0.004). This was contrary to a report by Geidam et al, from Maiduguri, 4 where duration of surgery was not a significant factor in the development of complications. This is probably because the authors also reported that most of the procedures in the Maiduguri study lasted between 60 and 120 minutes.…”

“…Operations are carried out in the gynaecological suites in the main operating theatre and transferred thereafter to the gynaecological ward for postoperative care. Patients are booked for clinic follow-up Where, N = minimum number of subjects that need to be enrolled in the study to have a statistical power of 80% p 0 = proportion of sample with postoperative complications from a similar study, 4 10.9% p 1 = proportion of sample with postoperative complications from this study group, 76.5% q 0 = 1 − p 0 q 1 = 1 − p 1 α = probability of type I error, 0.05 β = probability of type II error, 0.02 z = critical value for a given α or β. Setting power at 80% (the minimum power), N = 128.…”

“…This is comparable with findings from Maiduguri, Nigeria 4 but differs from results of other studies in which menorrhagia was found to be the commonest presenting complaint. 4,14,21,22 The difference may be that this review had a more selective study sample, while others were epidemiologic descriptive studies of larger sample size. All the same, the presence of a large fibroid seems to be a more common reason to require surgery in our environment.…”

“…3 The incidence of abdominal myomectomy in southwestern Nigeria has been reported as 54.7%, 2 while a rate of 3.34% has been reported for Maiduguri, northeastern Nigeria. 4 Abdominal myomectomy is the commonest method of treating uterine fibroids and accounts for 60.4% of cases in Ilorin 5 and for 90% of cases in southeastern of Nigeria.…”

Laparoscopic myomectomy - a three year experience

“…8 One meta-analysis showed that the laparoscopic approach is associated with longer operating times, less blood loss, less postoperative pain and fewer complications than open conventional myomectomy. 9 The choice of open laparotomy or laparoscopic myomectomy depends upon the availability of facilities and expertise of surgeons. The size and number of fibroids may make laparoscopic myomectomy inappropriate.…”