Cesarean myomectomy trends and controversies: an appraisal.
OBJECTIVE
Although the first report on cesarean myomectomy (CM) was a century ago, the management of a myomectomy during a cesarean section (CS) remains controversial. The objective of this study is to provide the latest data on this topic regarding the techniques and complications of CM.


METHODS
The authors consulted the most important scientific databases investigating the indications and contraindications for CM, the operational techniques, benefits and complications.


RESULTS
CM provides the benefits of two surgeries in one laparotomy, avoiding the risks of repeated anesthesia and relaparotomy. Nevertheless, in some patients, CM may be associated with increased morbidity and, in such cases, an interval myomectomy might be a safer option. Myomas compromising fetal extraction and uterine incision and/or suturing should be preferably enucleated during CS. CM is generally considered relatively safe in cases of anterior wall myomas, subserous and pedunculated myomas, particularly if a myomectomy is feasible without additional hysterotomy. Multiple myomas, deep intramural, fundal and cornual myomas and posterior uterine wall myomas are associated with more surgical complications during CM.


CONCLUSIONS
With increasing reports in favor of CM, the risk-benefit ratio should be still evaluated with randomized controlled trials, in order to achieve more data on CM.
a Clinic of Gynecology and Obstetrics, Clinical Center of Serbia , Belgrade , Serbia.|b School of Medicine, University of Belgrade , Belgrade , Serbia.
Radmila
R
Sparić
c International Translational Medicine and Biomodeling Research Group, Department of Applied Mathematics Moscow Institute of Physics and Technology, Moscow State University, Russia.|d Department of Obstetrics & Gynecology , Santa Maria Hospital, GVM Care & Research , Bari , Italy.
Antonio
A
Malvasi
a Clinic of Gynecology and Obstetrics, Clinical Center of Serbia , Belgrade , Serbia.|b School of Medicine, University of Belgrade , Belgrade , Serbia.
Saša
S
Kadija
a Clinic of Gynecology and Obstetrics, Clinical Center of Serbia , Belgrade , Serbia.|b School of Medicine, University of Belgrade , Belgrade , Serbia.
Ivana
I
Babović
e Clinic of Gynecology and Obstetrics "Narodni Front" , Belgrade , Serbia , and.
Lazar
L
Nejković
c International Translational Medicine and Biomodeling Research Group, Department of Applied Mathematics Moscow Institute of Physics and Technology, Moscow State University, Russia.|f Division of Experimental Endoscopic Surgery , Imaging, Technology and Minimally Invasive Therapy, Department of Obstetrics and Gynecology Vito Fazzi Hospital , Lecce , Italy.
Andrea
A
Tinelli
D016022:Case-Control Studies; D002585:Cesarean Section / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007889:Leiomyoma / Q000601:surgery*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000601:surgery*; D012189:Retrospective Studies; D063186:Uterine Myomectomy / Q000379:methods*; D014594:Uterine Neoplasms / Q000601:surgery*
Cesarean myomectomy; cesarean section; complication; myoma; technique