Review of the conservative surgical treatment of uterine fibroids

Abstract

The conventional surgical treatment for women with symptomatic uterine fibroids is a hysterectomy. Hysterectomy guarantees the removal of all uterine fibroids without a risk of recurrence. It also guarantees the cure of symptoms such as menorrhagia and pressure effects and has been shown to be associated with a high degree of patient satisfaction and improved quality of life scores. However, in addition to women who desire fertility, there are a growing number of women who have completed their family who do not wish to undergo a hysterectomy. Uterine conserving surgical methods include myomectomy or fibroid shrinkage either by embolisation/laparoscopic clipping of both uterine arteries or myolysis. This article reviews the surgical alternatives to hysterectomy and analyses the data that is currently available with each method. Laparoscopic interstitial laser photocoagulation of uterine fibroids is a relatively new modality of treatment and is carried out in our centre. Results of this method are presented and discussed in this article. Myomectomy is associated with significant morbidity and difficulty in long term management because of high recurrence rates. Surgical alternatives to myomectomy are still limited to large series in a few centres with a special interest in the procedure developed. Well designed long term studies are required to properly evaluate the efficacy and feasibility of each procedure in normal practice and its effect on infertility.