Abdominal trachelectomy in a case of cervical myoma as a fertility sparing surgery

Abstract

Cervical leiomyoma is considered a rare pathology with limited treatment options especially if preserving fertility is a concern. Traditional fertility-preserving surgery such as myomectomy has been the mainstay of management if it is possible (Ferrari F, Forte S, Valenti G, Ardighieri L, Barra F, Esposito V, etal. Current treatment options for cervical leiomyomas: a systematic review of literature. Medicina (Kaunas) 2021;57:1-15). Trachelectomy was described as fertility-preserving surgery in patients with early-stage cervical cancer. However, recent studies manage patients with trachelectomy for benign pathology and suggest that; it as an alternative option that otherwise will be treated as hysterectomy (Ferrari F, Forte S, Valenti G, Ardighieri L, Barra F, Esposito V, etal. Current treatment options for cervical leiomyomas: a systematic review of literature. Medicina (Kaunas) 2021;57:1-15). A 33-year-old female, Para 3, referred to a gynecology clinic with a history of heavy menstrual flow, pelvic pain and pressure symptoms. She is known case of fibroid uterus however after having done pelvic MRI with contrast it confirmed the diagnosis of cervical myoma, measured 10cm × 10 cm, which is intraoperatively managed by trachelectomy as a fertility preservation surgery. The surgery was complicated by ureterovaginal fistula, which was managed with a DJ stent conservatively. Cervical myoma is a rare pathology, and trachelectomy should be considered as an option for a woman who wants to preserve her fertility. Complication and obstetrical outcome should be discussed with the patient; hence, more studies are needed to address the management of cervical myoma, surgical complications and outcome of this procedure, especially in a benign condition.