Endometrial Myomectomy: A New Soul in Caesarean Myomectomy
Journal Title: Interventions in Gynaecology and Women’s Healthcare - Year 2018, Vol 2, Issue 1
Abstract
Study objective: To introduce a new surgical technique to the clinical practice by comparing the perop and early postop outcomes of endometrial myomectomy is to serosal myomectomy during caesarean section. 22 cases which consented for endometrial myomectomy were enrolled to Group1 and 24 cases which had serosal myomectomy were included in the control group as Group 2 that has been applied in our practice. Posteriorly located myomas and asymptomatic cases were excluded in both groups. All findings related to the myoma including location, size and the number of the myomas were recorded. Blood loss during surgery, haematological course during pre and postoperative period, the need for blood Transfusion, total time of surgery, and hospital stay was also documented. Conclusion: Endometrial myomectomy seems to be a safe, easily applicable surgical technique as compared to serosal myomectomy. The risk of adhesion formation and intra operative blood loss are less.Confronting leiomyomas during the course of pregnancy and/ or incidentally during caesarean sections becomes more prevalent due to postponing childbearing and advanced maternal age. The prevalence of leiomyomas in pregnancy ranges from 0.37% to 12% in the current literature [1-3]. Performing myomectomy during caesarean section is a hot topic of debate though huge number of publications supporting caesarean myomectomy. Weak outcomes were observed from meta analyses and quality of evidence from the study was low and sporadic, it seems that the controversy will continue until randomised controlled large scale studies with long term outcomes held to finish the debate. Heavy bleeding and increased surgical morbidity, prolongation of surgical time, the need for blood transfusions and a longer hospital stay are top concerns about caesarean myomectomy when it is performed during caesarean section [4]. However, accumulating the number of publications to support caesarean myomectomy in recent years is merging. The main concern of the serosal myomectomy during caesarean section is to remove leiomyomas to avoid additional surgery and diminish the morbidity arises from second surgery. Tinelli et al [5]. break the chains and presented that serosal myomectomy had a minimal impact on blood loss and found no difference in blood transfusion rates when it performed during caesarean section [5]. Endometrial myomectomy is an inspirational technique to reduce the risks attributed to the serosal myomectomy. It is well known that uterine size increases 20 times during pregnancy and uterine volume increases 1000 times while myomas during pregnancy can grow 25% of their size which means that myomectomy during caesarean section will have less surgical scar than a myomectomy of non pregnant uterus. But reaching from the serosal site still has the risk of adhesion formation and risk of haemorrhage during surgery. Performing myomectomy from the endometrial site is inspitared from the hysteroscopic myomectomies where myomas are removed from the endometrial site without suturing the endometrium. Here in this technique, we use the same principle to remove the leiomyomas from the endometrial approach a soon as the baby and the placental materials taken out. Uterus itself is the main supporting factor since uterine involution diminishes the surgical site, the death space of myoma capsule and squizes the large blood vessels and haemorrhage risk decreases. In cases where the surgical site is less than 3cm, no need to put sutures to the endometrium in order to diminish the chance of Ashermann syndrome. 46 cases were enrolled in this retrospective study. Endometrial myomectomy started to be performed in our clinic as a routine practice since 2013. The study group (Group 1) consisting of 22 consecutive patient underwent endometrial myomectomy. The control group was matched based on the same anterior uterine wall leiomyoma cases (Group 2) performed again in the same institution between 2013 and 2014. All 46 leiomyoma cases were symptomatic and diagnosed with Mild pelvic pain in the course of pregnancy and clinically accepted as symptomatic myomas after the differential diagnosis. Exclusion criteria was posterior uterine wall leiomyoma, pedunculated serosal leiomyoma, patients underwent both endometrial and serosal myomectomy at the same time cases with asymptomatic leiomyoma were also studied. Caesarean myomectomy cases were collected from the operation records and their files were derived from the archives and patients were divided into two groups.
Authors and Affiliations
Şafak Hatirnaz
Keywords
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- EP ID EP573194
- DOI 10.32474/IGWHC.2018.02.000129
- Views 91
- Downloads 0
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