The occasional need for myomectomy.

Only occasionally is there a good indication for either abdominal myomectomy or vaginal myomectomy. Among 3205 patients who had major gynecologic operations, 1022 had leiomyofibromas; 718 needed abdominal hysterectomy, 253 needed vaginal hysterectomy, and only 51 were treated by myomectomy. Vaginal myomas and a few submucous uterine myomas were excised vaginally. Parasitic myomas and a few intramural myomas were excised abdominally. Indications, symptoms, number, size, tissue characteristics, methods, subsequent fertility, and subsequent pelvic operations are all discussed. In 26 of these patients, myomas were discovered during other conservative gynecologic operations, requiring decision-making during operations; criteria are discussed.