Myomectomy

Reproductive Uterine Surgery

“…In addition, many series report pregnancy rates of 35 to 50% subsequent to myomectomy in unselected patients, implying that the myomata were the cause of the infertility. [39][40][41][42]54 Some series [55][56][57][58][59] report similar results for those patients whose indication for surgery was solely infertility. My own work 60 suggests that a careful search must be made for other fertility-compromising factors before infertility is attributed solely to myomata and subsequent pregnancy to their removal.…”

“…In this country, reports by Rubin, 39 Davids, 40 Finn and Muller, 41 and Ingersoll 42 contributed to the growing acceptance of the procedure.…”

“…Because of their recurrent nature, and because it is not always possible to remove all myomata at the time of surgery, reoperation is often necessary in the form of another myomectomy or hysterectomy. The rate for subsequent surgery ranges from 5 to 45% [40][41][42][55][56][57][58][59][60][61] Not all hysterectomies are performed for recurrent myomata. Malone 69 found that patients with multiple myomata were more likely to require future definitive surgery, and were less likely to conceive and carry to term than those patients with a single myoma.…”

“…The routine use of cesarean section is probably not indicated following myomectomy. In the ab- 41 Davids 40 Brown et al 55 Ingersoll 42 Brown et al 57 Loeffler, Noble 56 Babaknia et al 58 Berkeley sence of infection, healing of the uterine incision line is strong; Davids 40 reported no cases of uterine rupture in his series of 1150 myomectomies, almost all those of who became pregnant being delivered vaginally. Brown 57 reports 7 patients with cavity entry during myomectomy who subsequently conceived; 5 were delivered vaginally.…”

Myomectomy in Infertile Jamaican Women

“…After myomectomy, five of these were delivered by cesarean section and four were operated on for intrapartum problems. Vaginal delivery has been recommended only if the endometrial cavity was not entered at myomectomy and if the patient experienced no postoperative uterine wound infection (1,3,5). However, Brown et al (2) have reported that five out of seven patients whose endometrial cavities were entered subsequently delivered vaginally.…”