Laparotomy Myomectomy: Epidemiology, Indications and Prognosis at Loandjili General Hospital (Republic of Congo)

Abstract

To describe the epidemiological profile of patients, list myomectomy indications and report their prognosis at Loandjili General Hospital. A descriptive cross-sectional study conducted from 1 January 2016 to 31 December 2018 in the Gynecology Department of Loandjili General Hospital, including exhaustively all patients operated for myomectomy. The variables studied were pre (age, gestity, parity, indication), per (myoma measures, blood loss, intraoperative transfusion, complications and peroperative incidents) and postoperatively (hospital stay). Ninety-two patients had been received for surgical management of uterine fibroids out of a total of 1,455 gynecological procedures or 6.3%. The median age was 36.5 years [range 27 - 44] with a peak in the 36 to 40 age group (37%). The median gestity and parity were respectively 2 [range 0 - 12] and 1 [range 0 - 7]. More than half of the patients were nulliparous (51.1%). In 71.7% of cases (n = 66), myomectomy was performed in a context of desire for maternity. Indications for myomectomy were hemorrhage (46.7%), large uterus above the umbilicus (37%) and pelvic pain (16.3%). The polymyomectomy was performed in 64.1% of the cases (n = 59) with nuclei of size varying between 2 and 20 cm. The morbidity was marked on the one hand by anemia (n = 14 or 14%) secondary to an intraoperative haemorrhage which resulted in two cases in performing a hemostatic hysterectomy and in the other by rupture of the uterine cavity. Postoperative blood loss was estimated at 200 to 1400 ml, resulting in more than half of the patients receiving blood transfusions (58%). Myomectomy by laparotomy is often accompanied by significant blood spoliation thus increasing the postoperative morbidity. Techniques that minimize intraoperative blood loss should be used for laparotomy myomectomy.