VAGINAL MYOMECTOMY

Gary F. Nobert, M.D. and Lisa Dabney, M.D.


   Objective: To examine the long-term outcomes of vaginal
myomectomy

   Methods: We retrospectively reviewed the records of 40 women who underwent 44 attempted vaginal myomectomies over 24 years. Outcomes measured were technical feasibility, blood loss, length of stay, complications, symptom resolution, follow-up length, and re-operation for fibroids, and later pregnancy.

   Results: Thirty seven of 44 attempted vaginal myomectomies were successful. Three were converted to laparotomy myomectomy, 2 to vaginal hysterectomy, and 2 abandoned. For (37) vaginal myomectomies the average blood loss was 194 cc (20-800cc). Hospital stay averaged 1 day (0-4). Symptoms resolved in 34 patients. Two major complications were cystotomy and bowel obstruction. Two patients required autologous blood transfusion, 1 had incisional cellulitis. Average follow-up was 93 months (1-283). Eight patients had 12 re-operations for symptomatic fibroids, including 5 attempted vaginal myomectomies (2 successful), 1 laparotomy myomectomy, and 7 hysterectomies. All 8 patients who tried to conceive later delivered successfully (4 twice); 3 had C/S for myometrial scars, 1 plans Caesarian hysterectomy.

   Conclusions: Vaginal myomectomy is a safe procedure, with low morbidity. Recovery is rapid, with short or same-day stay. This procedure can be offered as an alternative for myomectomy in selected cases.

   Keyword: vaginal myomectomy