Relative morbidity of abdominal myomectomy for very large uterine fibroids in a developing country hospital

Abstract

Data on comparative outcomes of abdominal myomectomy for varying uterine sizes that could guide informed decision by women and clinicians in resource-constrained settings are scarce. To evaluate safety of abdominal myomectomy and compare perioperative morbidities for women with very large uterine size (≥20 weeks) with that of women with smaller uterine size (<20 weeks) in a developing country hospital. Retrospective and comparative chart review of 224 women with uterine sizes between 12 and 36 weeks who had abdominal myomectomy performed at a Nigerian university hospital. Primary outcome measure was overall perioperative morbidity, with the following secondary outcomes: hemorrhage, febrile morbidity, unintended major surgical procedures, life-threatening events, and rehospitalization (according to validated criteria). Other variables included operating time, estimated blood loss, wound complications and postoperative hospital stay. Overall morbidity occurred in 31.7% of women with hemorrhage (20.5%) and febrile morbidity (16.1%) being leading contributors. Unintended procedures (0.9%) and life-threatening events (1.8%) were rare and no death was recorded. Forty women (17.9%) had blood loss ≥ 1 l and 11.6% received homologous blood transfusion. Overall morbidity and all secondary morbidity outcomes (according to predefined criteria) were comparable between women with very large uterine size and those with smaller uteri. However, the mean blood loss was significantly more and the procedure and average hospital stay were significantly longer in women with very large uterine size. Abdominal myomectomy in this setting is associated with significant but acceptable perioperative morbidity. Increased uterine size does not significantly affect clinically important morbidities and women with very large uterine size should not be denied this procedure for safety concerns.