Myomectomy performed concurrently with tuboplasty.
OBJECTIVE
To determine whether women who require tuboplasty for infertility and have associated uterine leiomyomas that require removal should have the myomectomy done concurrently.


METHODS
Eighty-nine infertility patients underwent tuboplasty alone for proximal tubal obstruction, 30 others were treated by both myomectomy and tuboplasty during the same operation, and 15 others underwent tuboplasty, leaving the myomas in situ. The tuboplasty in all cases consisted of tubal resection and anastomosis (TRA). The pregnancy rates and outcomes in the three groups were compared.


RESULTS
Of the 89 patients who underwent TRA alone, 74.2% (66 patients) became pregnant, and of those 66, 15.2% had a spontaneous miscarriage, 24.2% developed an ectopic pregnancy, and 60.6% achieved a viable birth. By comparison, of 30 patients who had both TRA and myomectomy, 63.6% (19 patients) conceived, and of those 19, 15.8% miscarried, 26.3% developed ectopic pregnancies, and 57.9% achieved viable births. Of 15 patients who underwent TRA leaving the myomas in situ, 73% (11) became pregnant, and of those 11, 45% (5) miscarried, 18% (2) had ectopic pregnancies and 36% (4) gave birth to viable infants. The incidence of pregnancies, ectopic gestations, miscarriages and viable births in the three groups showed no statistical differences.


CONCLUSIONS
When myomectomy is indicated, because of the lack of disadvantages of performing it at the time of tuboplasty, the combined surgical approach should be the procedure of choice rather than leaving the myomas in situ for their removal in a separate operation at a later date.
Guillaume
A J
AJ
Department of Obstetrics and Gynecology, Catholic Medical Center of Brooklyn and Queens, New York, New York, USA.
Benjamin
F
F
Spitzer
M
M
D000022:Abortion, Spontaneous / Q000453:epidemiology; D005184:Fallopian Tube Diseases / Q000150:complications* / Q000601:surgery; D005187:Fallopian Tubes / Q000601:surgery*; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000601:surgery*; D007889:Leiomyoma / Q000150:complications* / Q000601:surgery; D009215:Myometrium / Q000601:surgery*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011271:Pregnancy, Ectopic / Q000453:epidemiology; D014594:Uterine Neoplasms / Q000150:complications* / Q000601:surgery