Serosal and Endometrial Reconstitution During Myomectomy

Abstract

Context : Myomectomy is usually performed when uterine fibroids are associated with infertility. Serosal and endometrial reconstitution are some of the subtle challenges that the gynaecologist has to deal with during myomectomy, in an attempt to minimise postoperative pelvic and intrauterine adhesions. Objective : This study was conducted to evaluate the effect of careful apposition of the serosa and endometrium on subsequent development of post-myomectomy pelvic and intrauterine adhesions and to assess the effect of resection of redundant endometrium on subsequent menorrhagia. Study Design, Setting, and Subjects : A review of 17 patients with previous myomectomy who eventually had a subsequent laparotomy for various indications between June 1992, and July 1998 in the University College Hospital, Ibadan was carried out. Main Outcome Measures : Operative findings at myomectomy, as well as therapeutic procedures performed on them were recorded. Patients' observation of changes in menstrual blood loss postoperatively was also recorded. The presence of pelvic adhesions at re-laparotomy and intrauterine adhesions on hysterosalpingography in those who had endometrial reconstitution was also noted. Results : Continuous closure was found to be beneficial in all cases of serosal defects. Excision of redundant endometrium in 11 women was associated with subjective reduction of menorrhagia in 9 of them. Conclusion : It is advisable that gynaecological surgeons strive to minimise areas of visceral trauma, ischaemia and abrasion during myomectomy. (Tropical Journal of Obstetrics and Gynaecology, 2001, 18(1): 16-18)