Uterine fibroid: clinical presentation and relative morbidity of abdominal myomectomy and total abdominal hysterectomy, in a teaching hospital of Karachi, Pakistan.

OBJECTIVE

To compare clinical presentation and morbidity of abdominal myomectomy and hysterectomy.

METHODS

We reviewed medical records of 441 patients with symptomatic fibroid, treated by myomectomy (135) or hysterectomy (306) at The Aga Khan University Hospital, Karachi, from January 1991 to December 1995. Z-test and risk estimates with 95% confidence intervals were calculated.

RESULTS

Pregnancy loss [Risk Ratio = 2.79, 95% Confidence Interval = 1.90-4.10], pelvic mass [Risk Ratio = 2.22, 95% Confidence Interval = 1.68-2.92] and infertility [Risk Ratio = 1.44, 95% Confidence Interval = 1.05-1.96] were more likely to be managed by myomectomy than in the absence of these complaints. Abnormal uterine bleeding was less likely to be treated by myomectomy than in its absence [Risk Ratio = 0.54, 95% Confidence Interval = 0.41-0.71]. With myomectomy, both the estimated mean intra-operative blood loss and the risk of febrile morbidity were significantly less than with hysterectomy [Mean (S.D.): 386 milliliters (48) versus 567 milliliters (62), p-value 0.000 and Risk Ratio = 0.37, 95% Confidence Interval = 0.16-0.87, respectively]. The risk of visceral injury [Risk Ratio = 2.24, 95% Confidence Interval = 0.74-6.82], blood transfusion [Risk Ratio = 0.69, 95% Confidence Interval = 0.44-1.07], mean duration of operating time [Mean (S.D.) 127 minutes (35) versus 131 minutes (47), p-value 0.93] and mean duration of hospital stay [Mean (S.D.): 5.44 days (1.28) versus 5.42 days (1.09), p-value 0.92] did not differ significantly between the groups.

CONCLUSION

Myomectomy can be considered as a safe alternative to hysterectomy for the surgical management of uterine fibroids, with an added advantage of preservation of women's sexual and reproductive functions.