[Enucleation of intramural uterine fibroids in women at fertile age: midterm results of prospective clinical trials].

OBJECTIVE

To analyze clinical and reproductive outcomes of patients after laparoscopic (LM) or open (OM) myomectomy.

DESIGN

Prospective clinical trial.

SETTING

Department of Obstetrics and Gynecology, 1st Faculty of Medicine and General Faculty Hospital, Charles University, Prague.

METHODS

Women under the age of 40 with intramural fibroid larger than 4 cm were indicated for myomectomy. LM was performed when laparoscopy revealed solitary or 2 fibroids smaller than 8 cm; otherwise the OM was carried out. The patients were followed at 6 months intervals.

RESULTS

80 myomectomies with extirpation of 121 myomas was performed from January 2002 to April 2005. The average age was 33.5 years, average size of dominant fibroid 56 mm. 38% of women suffered from infertility; the mean follow-up was 15.6 months. We performed LM in 56 cases (70%). From 24 open procedures 18 were elective and 6 converted from laparoscopy. In 18 patients some of the fibroid--ischemization procedures (uterine arteries embolization or laparoscopic dissection, or laparoscopic myolysis) preceded myomectomy. In the group with LM there was significantly lower peri-procedural blood loss, lower count of leucocytes and CRP concentration the 2nd day after surgery, shorter stay in the hospital, shorter interval between surgery and conception, and lower incidence of early complications than in women with OM. Fibroid related symptoms fully disappeared in 76% of patients. 20 women from 38 that have already tried to conceive have achieved 22 gestations so far: 9 deliveries (2 preterm; 3 vaginal, 6 Cesarean), 6 miscarriages, 1 ectopic and 6 ongoing pregnancies at the moment.

CONCLUSION

In the hands of surgeons experienced in operative laparoscopy the enucleation of intramural uterine fibroids is safe, symptomatically effective, mostly low invasive procedure with good reproductive prognosis.