Vaginal Myomectomy: A Realistic Alternative?

Abstract

The object of this study was to compare the morbidity of vaginal myomectomy and abdominal myomectomy in the surgical management of uterine leiomyomas. Hospital records were reviewed retrospectively for all women who underwent vaginal myomectomy (VM, n = 52) performed exclusively vaginally or after previous diagnostic laparoscopy, and abdominal myomectomy (AM, n = 97) between January 1, 1993, and July 31, 1998, for the preoperative diagnosis of leiomyoma. There were significant differences between the two groups for average age (AM 37.8 years, VM 41.3 years, p < 0.001), mean parity (AM 0.7, VM 1.2, p < 0.002), average number of myomas (AM 1.8, VM 1.4, p < 0.007), mean myoma weight (AM 418.1 g, VM 205.5 g, p < 0.0001), and hospitalization time (AM 7.8 days, VM 6.5 days, p < 0.0001). Preoperative use of gonadotropin releasing hormone agonists, operative time, and mean myoma size were similar in the two groups. There was no significant difference between the two groups with regard to transfusion rates, decrease in hematocrit, or febrile morbidity. There was one visceral injury in the VM group and none in the AM group. Eleven patients who first underwent VM were converted to AM because of a myoma inaccessible vaginally or intraoperative complications. Vaginal myomectomy appears to be an interesting alternative to abdominal myomectomy and compares favorably with regard to the hospitalization time in the surgical management of leiomyomas. However, that procedure should be performed by surgeons trained in vaginal surgery and is indicated for screened patients, preferably multiparous, with one single posterior leiomyoma. (J GYNECOL SURG 16:63, 2000)