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      Complications of Uterine Fibroids and Their Management, Surgical Management of Fibroids, Laparoscopy and Hysteroscopy versus Hysterectomy, Haemorrhage, Adhesions, and Complications

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          Abstract

          A critical analysis of the surgical treatment of fibroids compares all available techniques of myomectomy. Different statistical analyses reveal the advantages of the laparoscopic and hysteroscopic approach. Complications can arise from the location of the fibroids. They range from intermittent bleedings to continuous bleedings over several weeks, from single pain episodes to severe pain, from dysuria and constipation to chronic bladder and bowel spasms. Very seldom does peritonitis occur. Infertility may result from continuous metro and menorrhagia. The difficulty of the laparoscopic and hysteroscopic myomectomy lies in achieving satisfactory haemostasis using the appropriate sutures. The hysteroscopic myomectomy requires an operative hysteroscope and a well-experienced gynaecologic surgeon.

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          Most cited references35

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          Laparoscopic versus abdominal myomectomy: a prospective, randomized trial to evaluate benefits in early outcome.

          Valerio Mais, Silvia Ajossa, Stefano Guerriero … (1996)
          Our purpose was to investigate the advantages of laparoscopic myomectomy versus laparotomy. A prospective, randomized trial was performed on 40 women, 22 to 44 years old, undergoing myomectomy. Patients were randomized to have laparoscopy (n=20) or laparotomy (n=20). The intensity of pain was assessed by a visual analog scale at 0, 1, 2, and 3 days postoperatively. The proportions of patients who were analgesic free on day 2, discharged from the hospital by day 3, and feeling fully recuperated on day 15 were also compared. The intensity of postoperative pain was lower (p<0.05) after laparoscopy than after laparotomy. A higher (p<0.05) proportion of patients was analgesic free on day 2, discharged from hospital by day 3, and feeling fully recuperated on day 15 after laparoscopy compared with laparotomy. Laparoscopic myomectomy may offer the benefits of lower postoperative pain and shorter recovery time in comparison with laparotomy.
          Article 0 comments Cited 48 times – based on 0 reviews     Review now
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            Laparoscopic surgery is not inherently dangerous for patients presenting with benign gynaecologic pathology. Results of a meta-analysis.

            C Chapron, G. Breart, J. B. Dubuisson … (2002)
            Laparoscopic surgery presents a large number of advantages over laparotomy. The goal of this work was to check whether these benefits outweigh any greater risk of complications. The study design was a meta-analysis of published data from prospective randomized clinical trials (RCT). For the period 1966 to June 2000 we searched Medline and Cochrane Controlled Trial Registers and asked the investigators for further details. Meta-analysis was carried out with the Cochrane review manager software RevMan 4.1. A total of 27 prospective RCT including 3611 women (1809 treated by operative laparoscopy and 1802 treated by laparotomy) were enrolled in the meta-analysis. The overall risk of complications was significantly lower for patients operated by laparoscopic surgery [relative risk (RR) 0.59; 95% confidence interval (CI) 0.50-0.70]. There was no statistically significant difference concerning the risk of major complications with respect to the approach used (RR 1.0; 95% CI 0.60-1.65). The risk of minor complications was significantly lower for patients operated by laparoscopic surgery (RR 0.55; 95% CI 0.45-0.66). Concerning the risks of readmission, second procedure and blood transfusion, there was no difference between the two groups. Identical results were found when we performed a sensitivity analysis including or excluding studies according to the methodological score. Subgroup analysis according to how serious the surgery was (minor, major, advanced) showed a significant increase in the risk of transfusion for advanced procedures performed by laparotomy. Laparoscopic surgery is not inherently dangerous for patients presenting benign gynaecological pathologies. The potential risk of complications should no longer be advanced as an argument against using laparoscopic surgery rather than laparotomy for an operation when the indication allows the choice.
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              Transcervical hysteroscopic resection of submucous fibroids for abnormal uterine bleeding: results regarding the degree of intramural extension.

              António Moreno, Mark Emanuel, K Wamsteker (1993)
              To examine the results of transcervical resection of submucous fibroids in relation to the degree of intramural extension. A prospective 3-year observational study was performed of transcervical resection of submucous fibroids for abnormal uterine bleeding. The mean follow-up was 20 months (range 10-34). Fifty-one patients with a mean age of 38 years (range 23-55) were treated with transcervical resection after classification according to the degree of intramural extension of the submucous fibroids. The intention was to perform complete resection, established at control hysteroscopy. A repeat procedure was performed in cases of incomplete resection unless the patient denied further hysteroscopic treatment. Outcome measures were control of bleeding, subsequent surgery, number of procedures, number of complete resections, and number of recurrences. Bleeding was controlled in 48 (94.1%) of all patients after final resection. Hysterectomy was performed in three patients (5.9%) because of persistent complaints: in two cases after incomplete resection and in one case after complete resection. Three patients were lost to follow-up. Of the remaining 45 patients (42 with complete and three with incomplete final resection), three (6.7%) had a recurrence (one after complete and two after incomplete final resection). With more extensive intramural involvement, the chance to achieve complete resection decreased and the mean number of procedures to achieve complete resection increased. Complete resection improves the long-term results of transcervical resection of submucous fibroids for control of abnormal uterine bleeding. Transcervical resection of submucous fibroids with more than 50% intramural extension should be performed only in selected cases, as complete resection usually necessitates repeat procedures.
              Article 0 comments Cited 38 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Obstet Gynecol Int
                Journal ID (iso-abbrev): Obstet Gynecol Int
                Journal ID (publisher-id): OGI
                Title: Obstetrics and Gynecology International
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 1687-9589
                ISSN (Electronic): 1687-9597
                Publication date (Print): 2012
                Publication date (Electronic): 9 April 2012
                Volume: 2012
                Electronic Location Identifier: 791248
                Affiliations
                Department of Obstetrics and Gynaecology, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
                Author notes

                Academic Editor: Giovanni Scambia

                Article
                DOI: 10.1155/2012/791248
                PMC ID: 3348525
                PubMed ID: 22619681
                SO-VID: 62189a84-cf7a-4447-9fce-0f4804f5a3d6
                Copyright © Copyright © 2012 Liselotte Mettler et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 15 November 2011
                Date revision received : 18 January 2012
                Date accepted : 8 February 2012
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Obstetrics & Gynecology
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology

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