Reoperation rates for recurrence of fibroids after abdominal myomectomy in women with large uterus.

Katherine J Kramer,Capricia Bell,Hanna Ozbeki,Maurice-Andre Recanati,Sarah Ottum,Jay M Berman,Damla Gonullu,Robert Jeenchen Chen

doi:10.1371/journal.pone.0261085

Abstract

BackgroundThe population of women undergoing abdominal myomectomy for symptomatic large fibroid uterus is unique. We seek to characterize the timing, risk factors as well as the presenting symptoms which led patients to undergo repeat surgery in this patient population.Methods and findingsWe followed 592 patients who underwent an abdominal myomectomy from March 1998 to June 2010 at St. Vincent’s Catholic Medical Center and presented later during the study period with a recurrence of symptoms attributable to a reemergence of fibroids and who chose to undergo repeat surgical management. Twelve percent of patients exhibited symptoms of fibroid uterus which led to reoperation within the study period. The mean age at repeat surgery was 44.1 ± 0.6 years old (n = 69) and the mean time between operations was 7.9 ± 0.3 years. Presentation was variable but included bleeding, pain and infertility. Patients presented for surgery with a significantly smaller sized uterus than at their initial surgery. Timing between surgeries correlated with age at initial surgery and uterine size but race, number of fibroids, aggregate weight of fibroids removed, operative time or blood loss at the initial surgery did not correlate. Data is suggestive that intraperitoneal triamcinolone may reduce reoperation rates but not timing of recurrence.ConclusionThese results may help in counseling patients, particularly younger women, on the risks of fibroid recurrence necessitating repeat surgery. Further research is necessary to assess if triamcinolone can alter fibroid reurrence in patients who undergo uterus sparing procedures.

Highlights

Uterine fibroids, or leiomyomas, are the most common benign tumors in premenopausal women
These results may help in counseling patients, younger women, on the risks of fibroid recurrence necessitating repeat surgery
We focus on a group of 64 women, who were admitted for uterine surgery after having previously undergone an open myomectomy for a large symptomatic fibroid uterus with a mean size equivalent to 20.9 ±0.5 weeks gestation

Summary

Introduction

Leiomyomas, are the most common benign tumors in premenopausal women. Non-surgical treatment of uterine fibroids include expectant management [4] and medical therapy, which include estrogen-progestin contraceptives, progestins [5, 6], levonorgesterel releasing intrauterine devices [7] and implants, progesterone receptor modulators [8] such as ulipristal acetate [9], mifepristone [10], and GnRH agonists [11], aromatase inhibitors [12] and selective estrogen receptor modulators such as raloxifene [13] These approaches may provide symptom relief, especially in situations where bleeding is the main complaint. We seek to characterize the timing, risk factors as well as the presenting symptoms which led patients to undergo repeat surgery in this patient population

Methods

Results

Discussion

Conclusion