Combining the uterine depletion procedure and myomectomy may be useful for treating symptomatic fibroids.
OBJECTIVE
To evaluate the therapeutic results of premyomectomy uterine depletion for the treatment of symptomatic fibroids, compared with myomectomy only.


METHODS
Controlled, clinical study without randomization.


METHODS
University-affiliated tertiary referral center.


METHODS
Four hundred eighty-six women with symptomatic fibroids warranting surgical treatment and who wished to retain their uteri.


METHODS
Ligation of the uterine arteries was performed by either an abdominal or a laparoscopic approach before myomectomy.


METHODS
Operation time, intraoperative blood loss, postoperative improvement of symptoms, and recurrence rates of fibroids.


RESULTS
Of 342 women with pathology-confirmed fibroids who were included in the study, 108 received myomectomy only (group I), and 234 underwent the uterine depletion procedure followed by myomectomy (group II). Average blood loss was 250 +/- 132.5 mL for group I and 50 +/- 26.9 mL for group II. For patients with menorrhagia, 79 (84%) of 94 women in group I experienced complete resolution; all of the 194 women (100%) in group II had resolution within 2 months of surgery. The recurrence rate of ultrasound-confirmed fibroids was 19.4% (21 of 108) in group I and 0% in group II. Of the sexually active patients who were not using contraception, 50% (49 of 98) in group I and 37.5% (15 of 40) in group II had a live birth.


CONCLUSIONS
This study demonstrates the value of uterine depletion before myomectomy for the management of patients with symptomatic fibroids. The procedure reduced blood loss during the operation, resulted in complete resolution of fibroid-related menorrhagia, and has the potential to prevent fibroid recurrence. Fertility capacity was apparently not compromised by this new treatment approach.
Liu
Wei-Min
WM
Department of Obstetrics and Gynecology, Taipei Medical University Hospital and Taipei Medical University, Taipei, Taiwan. weiminliu50@hotmail.com
Tzeng
Chii-Ruey
CR
Yi-Jen
Chen
C
Wang
Peng-Hui
PH
D000328:Adult; D001158:Arteries / Q000601:surgery; D016063:Blood Loss, Surgical; D004564:Electrocoagulation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D007889:Leiomyoma / Q000150:complications / Q000601:surgery*; D008026:Ligation; D008595:Menorrhagia / Q000209:etiology; D008875:Middle Aged; D011300:Preoperative Care; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000150:complications / Q000601:surgery*; D014599:Uterus / Q000098:blood supply*