Open Abdominal Myomectomy Research Articles

Abstract 5055: Genetic background of recurrent uterine leiomyomas

Abstract Uterine leiomyomas, also known as fibroids, are common benign smooth muscle tumors in women of reproductive age. Leiomyomas can cause symptoms that can significantly reduce the quality of life. Treatment mainly involves hysterectomy or myomectomy, the latter for women who wish to preserve their uterus. Most leiomyomas harbor one of the three driver mutations affecting either MED12, HMGA2, or FH. Recently identified rare subtypes include tumors with mutations in genes linked to the neddylation of the Cullin 3-RING E3 ligase or SRCAP complex. Recurrence of leiomyomas is poorly understood in relation to their clonal origins and molecular factors. The aim of this study was to characterize the mutational profiles of leiomyomas from recurrent operations and to identify the frequency of clonally related tumors. We utilized a retrospective cohort of 234 women who underwent laparoscopic or open abdominal myomectomy, with 46 (20%) of them experiencing multiple procedures related to leiomyomas. We examined the mutation profiles of 133 leiomyomas (62 index and 71 recurrent tumors) from 33 patients who required multiple tumor removal surgeries. We screened the tumors for the three primary leiomyoma drivers—MED12 mutations, HMGA2 overexpression, and FH-deficiency—to identify potentially clonal tumors. We found that 21 out of 33 (64%) patients had tumors from multiple operations with identical leiomyoma driver alterations. To further assess the clonal relationship, we executed whole exome sequencing on these 52 tumors. We identified three patients with two clonally related tumors each through shared somatic copy number alterations and point mutations. The clonally related tumors included HMGA2, FH, and wild-type tumors. Notably, leiomyomas with MED12 mutations—the most common molecular leiomyoma subtype—were not found among the clonally related tumors. Three patients harbored numerous FH-deficient tumors from recurrent operations. In all those patients, we found FH germline mutations, characteristic of Hereditary Leiomyomatosis and Renal Cell Cancer syndrome (HLRCC). Moreover, we identified somatic mutations in YEATS4, a member of the SRCAP complex, in four recurrent tumors from three patients. Interestingly, all YEATS4 mutations were different, and the tumors were not clonally related. Further research is required to elucidate the role of YEATS4 in leiomyoma recurrence. In conclusion, our systematic study confirms that reinterventions are common after myomectomy, and while uterine leiomyomas typically develop independently, some share a clonal origin. Additionally, we show that recurrence may be due to genetic predispositions, such as germline FH mutations. Citation Format: Sara Khamaiseh, Anna Äyräväinen, Maare Arffman, Siiri Reinikka, Annukka Pasanen, Ralf Bützow, Päivi Härkki, Pia Vahteristo. Genetic background of recurrent uterine leiomyomas [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5055.

Effectiveness of the use of intravenous tranexamic acid and pericervical tourniquet in decreasing peri-operative blood loss following open abdominal myomectomy:A randomized controlled trial.

Uterine fibroid is the most common gynaecological tumour, with a prevalence of 20% to 50% of women over 30years.Abnormal uterine bleeding is one of the most common modes of presentation with menorrhagia. Open abdominal myomectomy is the most common treatment option in our environment. It is associated with a significant degree of blood loss, with consequent blood transfusion. Thus, the need for interventions to reduce blood loss during the procedure. This study assessed the effectiveness of intravenous tranexamic acid in reducing blood loss when used as an adjunct to peri-cervical tourniquet during open abdominal myomectomy. This study was conducted at Barau Dikko Teaching Hospital, Kaduna. It comprised thirty-six consenting patients scheduled for elective open abdominal myomectomy, randomly assigned to receive either intravenous tranexamic acid or placebo immediately after securing intravenous access in the theatre. All the patients had a peri-cervical tourniquet applied intraoperatively. The volume of intraoperative blood loss, blood transfusion rate and the total number of units transfused, haemodynamic changes associated with blood loss, and the complications associated with the use of tranexamic acid were evaluated during the first 72hours following the surgery. A total of thirty-six women who met the eligibility criteria were studied between June 2023 and December 2023. The mean age of the participants in the tranexamic acid group was 37.82 ± 5.89 years and 39.74 ± 5.17 years in the placebo group (p = 0.307). Most of the women 35 (97.2%) presented with symptoms of menorrhagia. Major blood loss > 1000 ml was recorded more among women in the placebo group than those who received tranexamic acid. There was a statistically significant reduction in the mean blood loss in the tranexamic acid group 947.65 ± 451.88 compared to 1320.53 ± 563.28. (p 0.037).There was an increase in the number of women who received a blood transfusion in the placebo group 7 (36.8%) compared to the tranexamic acid group 4 (23.5%) (p=0.387). Tranexamic acid resulted in a decrease in the risk of perioperative blood loss by 30%, RR 0.7 95% CI (2.19-2.59) and packed cell volume was significantly lower in the control group postoperatively (P value = .001). There was no significant side effect noticed in both groups. Tranexamic acid reduces blood loss during and after myomectomy for patients with uterine fibroids and the need for blood transfusion is reduced in patients who had intravenous tranexamic acid as an adjunct to the application of a tourniquet.

Giant "Hydra Headed" Uterine Fibroid in a Nullipara: A Case Report.

Uterine fibroids, or Leiomyoma is a type of Smooth Muscle Tumors of the uterus (SMTs) and are common in the black race. Giant uterine fibroids, on the other hand, are uncommon and may occur during patient dissimulation. Dissimulation may occur because of a dread of surgery and hospitals visits, fear of surgical death, chronic intake of herbal concussion, and a religio-traditional strong belief system on instant healing following prayers, among others. Myths like belief of defecating the uterine fibroids, some herbs that can melt them away, and the belief that such illness may follow ancestral curses can fuel dissimulation. The surgical approach can be a source of challenge, careful case selection considering the size and number of tumors can be helpful. We present a 35-year-old nulligravida who presented to the clinic with a 14-year history of progressive abdominal swelling. Examination revealed a firm mass with a symphysio-fundal height of 55 cm. She subsequently had an open abdominal myomectomy with all the myoma nodules weighing 12.9 kg in total! Histology confirmed uterine fibroid. It is possible to offer open myomectomy in patients with giant uterine fibroid following careful patient selection with a consent for possible hysterectomy. Dissimulation can be minimized with repetitive counseling of patients. The choice of surgery depends on the size and number of uterine fibroids, but surgical approach does not necessarily influence fecundity.

Association of Myomectomy With Anti-Müllerian Hormone Levels and Ovarian Reserve.

To assess whether open and minimally invasive myomectomy are associated with changes in postoperative ovarian reserve as measured by serum anti-müllerian hormone (AMH) level. This prospective cohort study included patients who were undergoing open abdominal myomectomy that used a tourniquet or minimally invasive (robot-assisted or laparoscopic) myomectomy that used vasopressin. Serum AMH levels were collected before the procedure and at 2 weeks, 3 months, and 6 months after surgery. The mean change in AMH level at each postsurgery timepoint was compared with baseline. The effect of surgical route on the change in AMH level at each timepoint was assessed by using multivariable linear regression. A subanalysis evaluated postoperative changes in AMH levels among the open myomectomy and minimally invasive myomectomy groups individually. The study included 111 patients (mean age 37.9±4.7 years), of whom 65 underwent open myomectomy and 46 underwent minimally invasive myomectomy. Eighty-seven patients contributed follow-up data. Serum AMH levels declined significantly at 2 weeks postsurgery (mean change -0.30 ng/mL, 95% CI -0.48 to -0.120 ng/mL, P=.002). No difference was observed at 3 months or 6 months postsurgery. On multiple linear regression, open myomectomy was significantly associated with a decline in AMH level at 2 weeks postsurgery (open myomectomy vs minimally invasive myomectomy: β=-0.63±0.22 ng/mL, P=.007) but not at 3 months or 6 months. Subanalysis revealed a significant decline in mean serum AMH levels in the open myomectomy group at 2 weeks (mean change -0.46 ng/mL, 95% CI -0.69 to -0.25 ng/mL, P<.001) postsurgery but not at three or 6 months. In the minimally invasive myomectomy group, no significant differences in mean AMH levels were detected between baseline and any postoperative timepoint. Myomectomy is associated with a transient decline in AMH levels in the immediate postoperative period, particularly after open surgery in which a tourniquet is used. Anti-müllerian hormone levels returned to baseline by 3 months after surgery, indicating that myomectomy is not associated with a long-term effect on ovarian reserve, even with the use of a tourniquet to decrease blood loss. This study was funded in part by a Roche Diagnostics Investigator-Initiated Study Grant.

Efficacy of Oxytocin in Reducing Blood Loss During Abdominal Myomectomy

Introduction: The drug of choice for preventing postpartum uterine atony and bleeding is oxytocin. Myomectomy is a procedure that may result in substantial bleeding. In about 20% women, transfusion of blood may be required during abdominal myomectomy. The objective was to compare the frequency of patients who needed blood transfusions with and without oxytocin during abdominal myomectomy. Place and duration of study: This was a randomized controlled trial carried out at the Department of Obstetrics and Gynecology of Sharif Medical Complex Lahore from 10th May 2018 to 10th November 2018. Material &amp; Methods: 108 patients having intramural uterine fibroid &gt; 5 cm in size, requiring planned elective open abdominal myomectomy were included and equally divided in both oxytocin and non-oxytocin groups(n=54). 30 IU oxytocin infusion (in 500 ml normal saline) / 120 milliliter per hour were administered during myomectomy, starting after administration of general anesthesia and completing just prior to surgery in patients of oxytocin group. An infusion of pure normal saline was administered at the same amount in the patients of non-oxytocin group. Blood loss was estimated and need for blood transfusion was determined in both the groups. Data was analyzed using SPSS version 24. P-value&lt;0.05 was considered significant. Results: Patients age ranged from 35 to 45 years with mean age of 40.481± 1.84 years in Oxytocin group while 40.425± 2.68 years in Non-Oxytocin group. Mean blood loss was 290.463±120.91 cc in Oxytocin group and 424.981±106.21 cc in Non-Oxytocin group. Need for blood transfusion was seen in 7.4% patients in Oxytocin group as compared to 25.9% in Non-Oxytocin group (p=0.009). Conclusion: Our study concludes that to reduce loss of blood during abdominal myomectomy, infusion of intra- operative oxytocin may be efficient and safe. To confirm these results, more studies with varied dosages and protocols are required.

Myometrial smooth muscle cells spillage during open myomectomy: Is it True or a myth?

BackgroundUncontained morcellation of myoma during laparoscopic surgery has been discouraged because of unknown malignancy. Even the safety of contained morcellation has been questioned because muscle cells have been detected in washings obtained during laparoscopic procedures. The possibility of myoma cell dissemination has been observed in open abdominal surgery, even after hysterectomy. Thus myomectomy would be unsafe from an oncological point of view, regardless of surgical approach. MethodsThis is an observational cohort study involving 30 patients who underwent open abdominal myomectomy. Peritoneal abdominal washings were obtained two times during the open abdominal myomectomy: before uterus incision and after the myomectomy itself. Cytological, cell block, and immunohistochemical evaluations were performed. ResultsAll washings obtained immediately after abdominal peritoneal cavity opening were negative for fibroid cells. Both the first and second washings were free of myoma cells. Cytologic evaluation did not reveal any smooth muscle cells. The results of desmin and smooth muscle actin staining, performed on the pre- and post-myomectomy samples, were negative. ConclusionOur results demonstrated, for the first time to our knowledge, that there is no dissemination of myoma cells during conservative abdominal surgery. It could represent an additional oncological safety. Further data are needed.

Technique to reduce blood loss during open abdominal myomectomy: transverse or vertical incision?

To determine if there is a difference between uterine incision techniques (vertical vs. transversal) in terms of clinical results. All women with leiomyomas who underwent open abdominal myomectomy (n=61) between March and August 2016 at the Gynecology and Obstetrics Clinic at the Women's Health Research and Training Hospital Zekai Tahir Burak were included, and the clinical results were included and prospectively reviewed. The estimated blood loss during myomectomy increased in the transversal group compared with the vertical group (809.33±483.34 versus 405.32±180.95 mL, p<0.001). The average operation duration was 60 min, and the patients got discharged on the second day after surgery. No intergroup statistical differences were observed in the surgical procedure. Surgeons should give preference to the most viable incision depending on the size and location of the leiomyoma.

Delayed presentation of giant uterine fibroids in a Nigerian private specialist health facility

Giant uterine fibroids (leiomyoma or myomas) which are fibroid masses greater than 11.4 kg are very rare. Although benign in nature, it may present with symptoms that impact negatively on the quality of life and health of the patient and impose greater management challenges. We present two cases of giant uterine fibroids that were successfully managed in a private specialist hospital without complications. Case 1 was a 38-year-old nulliparous Nigerian woman who presented with giant uterine fibroids (11.6 kg) who initially had delay of surgery due to fear that after surgery she may lose her “womb” or not be able to conceive after the operation. Later, she had successful open abdominal myomectomy, with the use of Foley catheters as improvise equipment for tourniquet and abdominal drain. Anti-adhesion agent was not used. Case 2 was a 47-year-old nulliparous Nigerian teacher with giant fibroids (13.2 kg) who also initially had delayed surgery due to fear that fibroid surgery is a major operation that it may get complicated and she may die. Also, she was afraid that she may not have her womb in her next world if she gets reincarnated. She had total abdominal hysterectomy and bilateral salpingo-oophorectomy without complications. For both cases, pre-surgery leiomyosarcoma assessment with computed tomography scan or magnetic resonance imaging and anti-adhesion agent were not used due to very unaffordable high costs. These reports of giant uterine fibroids (leiomyoma or myomas) are very rare gynecological entity, and management can be successful despite overwhelming challenges in low-income countries. Cheaper, affordable and available alternatives (improvises) can be resorted to for tackling its challenges in low-income settings.

A comparison of three approaches for laparoscopic single-site (LESS) myomectomy: conventional, robotic, and hand assisted.

The objective of this study is to determine the feasibility and explore criteria for patient selection for three methods of LESS myomectomy: conventional (C-LESS), robotic-assisted (RA-LESS), and hand-assisted (HA-LESS). This was a retrospective case review of 72 patients with uterine myomas, conducted in a large academic tertiary care hospital between March 1, 2015, and November 7, 2018. LESS myomectomy via conventional, robotic, and hand-assisted routes. 43 patients underwent C-LESS, 15 underwent RA-LESS, and 14 underwent HA-LESS, with no conversions to open abdominal myomectomy. The operative outcomes were compared across the three approaches. The HA-LESS group had the largest mean number (HA: 6.9; C: 3.7; RA: 2.9, P=0.001), diameter (HA: 11.3 cm; C: 9.3 cm; RA: 7.1 cm, P=0.035), and weight (HA: 850.1 g; C: 320.7 g; RA: 181.1 g, P=0.003) of myomas removed per patient. The use of this method was also found to have a direct correlation with estimated preoperative uterine size (HA: 20.1 weeks; C: 16.2 weeks; RA: 12.0 weeks, P=0.001. Operative time and postoperative stay were found to be not statistically different across groups. We conclude that all three types of LESS myomectomy are feasible with comparable surgical outcomes. Most importantly, our findings indicate that hand assistance can be combined with C-LESS myomectomy for large or multi-fibroid uterus without compromising operating time or patient recovery. Notably, we found that uterine size could be a useful tool for the determination of the surgical approach.

Quality of Life after Laparoscopic and Open Abdominal Myomectomy

To evaluate the baseline and postoperative changes in quality of life and symptom-severity scores in women undergoing laparoscopic or open abdominal myomectomy for symptomatic myomas. Prospective cohort study of patients choosing myomectomy for symptomatic uterine myomas. Academic medical center. A total of 143 women enrolled in the study. Of these, 80 women completed both a preoperative questionnaire and at least 1 postoperative questionnaire between 6 and 27 months after surgery. A total of 52 women had open abdominal myomectomy, and 28 had laparoscopic myomectomy between October 2014 and September 2017. The results of the Uterine Fibroid Symptom and Health-Related Quality-of-Life Questionnaire were compared before and after laparoscopic or open myomectomy. Women undergoing open abdominal myomectomy had larger and more numerous myomas than women undergoing laparoscopic myomectomy. Baseline quality-of-life scores were less adversely affected for women having laparoscopic myomectomy (mean [standard deviation], 57 [24] laparoscopic vs 43 [19] open abdominal, p = .01). However, baseline symptom-severity scores were statistically similar (49 [22] for laparoscopic and 57 [20] for open abdominal, p = .08) approaches. Six to 12 months after surgery, both open abdominal and laparoscopic surgeries provided excellent and similar improvements in symptom-severity and quality of life (postoperative symptoms severity scores, mean [standard deviation], 20 [14] laparoscopic vs 13 [11] open abdominal, p = .24 and quality-of-life scores, mean [standard deviation], 91 [16] laparoscopic vs 88 [17] open abdominal, p = .49). These improvements were sustained for women who returned questionnaires up to 27 months of follow-up. Women with symptomatic myomas have a compromised quality of life, and they experience a similarly dramatic improvement in quality of life and decrease in symptom-severity after both laparoscopic and open abdominal myomectomies.

Necessity of Combined Spinal Epidural Technique Duringopen Abdominal Myomectomy for Huge Uterine Fibroids

Background: Open abdominal myomectomy is commonly done to remove uterine fibroids which plague several Africans and people of African origin especially at the prime of their reproductive careers. Various anaesthetic techniques have been described for this surgical procedure. Some of the techniques have disadvantages.&#x0D; Objective: The aim of this study was to demonstrate the necessity and safety of the combined spinal epidural technique during open abdominal myomectomy for huge uterine fibroids.&#x0D; Methodology. A 5 years prospective study of 100 women with huge uterine fibroids, who had open abdominal myomectomy with combined spinal epidural (CSE) technique at Nimley Medical Consultants hospital, Kelsey Harrison hospital and the University of Port-Harcourtteaching hospital, was done. Data collected were analyzed with statistical package for social sciences (SPSS) version 17.0.P value &lt; 0.05 was regarded as statistically significant.&#x0D; Results. The mean age of the women was 32.53 ± 0.66 years. The mean fibroid size was 30.15 ± 0.68 weeks and the mean surgical duration was 178 .98 ±3.31 minutes. The epidural component of the CSE was activated after a meantime of 106.15±3.22minutes from the initiation of spinal anaesthesia at a mean numeric pain rating score (NRS) of ? 3cm. The rate of perioperative complications was low.&#x0D; Conclusion. Combined spinal epidural technique is a safe and necessary technique with relatively low rate of perioperative complications when used during open abdominal myomectomy for commonly found huge African fibroids.

Necessity of combined spinal epidural technique duringopen abdominal myomectomy for huge uterine fibroids

Background: Open abdominal myomectomy is commonly done to remove uterine fibroids which plague several Africans and people of African origin especially at the prime of their reproductive careers. Various anaesthetic techniques have been described for this surgical procedure. Some of the techniques have disadvantages.&#x0D; Objective: The aim of this study was to demonstrate the necessity and safety of the combined spinal epidural technique during open abdominal myomectomy for huge uterine fibroids. Methodology. A 5 years prospective study of 100 women with huge uterine fibroids, who had open abdominal myomectomy with combined spinalepidural (CSE) technique at Nimley Medical Consultants hospital, Kelsey Harrison hospital and the University of Port-Harcourtteaching hospital, was done. Data collected were analyzed with statistical package for social sciences (SPSS) version 17.0.P value &lt; 0.05 was regarded as statistically significant.&#x0D; Results. The mean age of the women was 32.53 ± 0.66 years. The mean fibroid size was 30.15 ± 0.68 weeks and the mean surgical duration was 178 .98 ± 3.31 minutes. The epidural component of the CSE was activated after a mean time of 106.15 ± 3.22minutes from the initiation of spinal anaesthesia at a mean numeric pain rating score (NRS) of &gt; 3cm. The rate of perioperative complications was low.&#x0D; Conclusion. Combined spinal epidural technique is a safe and necessary technique with relatively low rate of perioperative complications when used during open abdominal myomectomy for commonly found huge African fibroids.

Labetalol Hypotensive Anesthetic Protocol paves the way to Safe Open Abdominal Myomectomy: Comparative study versus Tourniquet Hemostasis

Study Hypothesis: Hypotensive protocol consisted of oral labetalol pre-medication and low-dose intraoperative (I0) labetalol infusion can improve surgical outcome of open abdominal myomectomy (OAM) than JO tourniquet compression.Study Design: Eighty-six women were randomly allocated into two equal groups: control group received normotensive anesthesia with application of uterine tourniquet for JO hemostasis and study group included patients followed the hypotensive protocol till completion of myomectomy. Surgical and anesthetic outcomes and surgeons' satisfaction were determined.Results: Three study patients required tourniquet application for control of bleeding. In study patients, mean field visibility score was non-significantly higher, but operative time, JO blood loss and need for transfusion were significantly lower and JO urine output was significantly higher. PO hemoglobin deficit was significantly lower. Hypotensive protocol allowed significant blunting of pressor reflexes to tracheal intubation and extubation and maintained non-singificant variations of heart rate (HR) and mean arterial pressure (MAP) measures during myomectomy. Postoperative HR and MAP measures were significantly lower in study patients compared to their baseline and to PO measures in patients of control group till 6-hr PO. Frequency of patients developed PO bleeding and hospital stay was significantly lower in study group. Surgeons' satisfaction by hypotensive anesthesia for OAM was non-significantly higher than by tourniquet hemostasis.Conclusion: Hypotensive anesthesia using oral labetalol pre-medication and low-dose JO labetalol infusion significantly reduced HR and MAP till immediate PO period versus classic JO tourniquet compression. Proper hemodynamic control significantly reduced open myomectomy associated bleeding complications, improved field visibility and so allowed perfect hemostasis within significantly shorter operative time than with tourniquet control of hemostasis.

Labetalol Hypotensive Anesthetic Protocol Paves the Way to Safe Open Abdominal Myomectomy

Labetalol Hypotensive Anesthetic Protocol Paves the Way to Safe Open Abdominal Myomectomy

Robotic-Assisted Laparoscopic Myomectomy versus Traditional Laparoscopic Myomectomy: Are They the Same?

The relative pros and cons of robotic-assisted laparoscopic myomectomy (RALM) and laparoscopic myomectomy (LM) are still debated. The short-term surgical outcomes such as estimated blood loss, need for blood transfusion, intra-operative complications, and conversion to laparotomy are similar for RALM and LM. Although RALM was previously thought to require longer operative time when compared to LM, recent studies show comparative surgical duration. On longer follow-up, high pregnancy rates and low pregnancy morbidity have been reported for both surgical approaches. The increased cost of RALM when compared to LM may be amortized in high-volume surgical centers. Specimen removal via power morcellation is limited by the FDA safety communication, but strategies for “contained” power and cold-knife morcellation may prevent unintentional fibroid spread. To conclude, RALM and LM are both safe minimally invasive alternatives to open abdominal myomectomy. Future technical developments may allow for the widespread implementation of single-site RALM and LM.

Clinical outcome after laparoscopic and open abdominal myomectomy

This paper details a retrospective study evaluating long-term outcomes after laparoscopic and abdominal myomectomy, including improvement of abnormal vaginal bleeding, periodic blood loss, pelvic pain, and fertility. This is a retrospective study based on a postal questionnaire and the women’s medical journal. A total of 233 women were identified as having had a myomectomy during the period 2003–2006 and were sent a postal questionnaire. The response rate was 70%. After surgery, pain score was significantly reduced. The number of days with bleeding and the degree of discomfort due to bleeding was also reduced after the surgery. Among 31% of the women who stated infertility as a reason for the myomectomy, 52% became pregnant during the observational period of 4.5 years on average. Few studies report long-term outcomes after laparoscopic and abdominal myomectomy. Despite the limitations of this retrospective study, the results imply improvements regarding periodic pain, number of days with bleeding and discomfort due to bleeding after myomectomy.

Gonadotropin-releasing hormone agonist pretreatment did not decrease postoperative adhesion formation after abdominal myomectomy in a randomized control trial

To determine if 3 months of preoperative gonadotropin-releasing hormone agonist (GnRH-a) treatment decreases postoperative uterine adhesions after open abdominal surgery for the removal of uterine fibroids. Prospective, randomized, clinical study. A tertiary care medical center. Women of reproductive age with symptomatic uterine fibroids not amenable to hysteroscopic removal. Twenty patients underwent an initial abdominal myomectomy followed by a second-look laparoscopy for evaluating uterine adhesions after random allocation to groups receiving either GnRH analog or placebo for 3 months before the initial surgery. Adhesion formation between treatment groups and by incision number and aggregate length. Presurgical GnRH-a treatment did not decrease adhesion formation compared with placebo. For every additional centimeter of incision length, the total adhesion area over the uterine serosal surface increased by 0.55 cm(2). The number of myomas removed and the number of incisions were positively correlated with total adhesion area. Preoperative treatment with GnRH-a for 3 months before open abdominal myomectomy did not decrease postoperative uterine adhesions. Following the standards of good surgical technique, adhesions are minimized with fewer and smaller incisions.

Myomectomy: TU Teaching Hospital experiences

Aim: To study, open myomectomy operation for uterine myoma/s as of present day practices in women ofreproductive age attending TU Teaching Hospital.Methods: This is a retrospective study where we reviewed the medical records of myomectomy cases from2060-2065(2003 April-2009 April).Result: Total 40 cases of myomectomy performed in TU Teaching hospital for myoma size varying from ≥ 10weeks (5), 12-16 weeks (15), 17-22 weeks (5), 23-28 weeks (5) and unknown (2) in women of reproductiveage [ 30-34(16), ≥ 29 (13), 35-39 (9), 40- 44 (1) and ≥ 45 (1)] in 13 (unmarried); nullipara (17); P1-2 (15)P3-4 (1) for reasons of infertility(12), dysmenorrhea (12), menorrhagia (8), urinary problems( 7) abdominalpain (3).At caesarean, myomectomy has been done in special circumstances for subbersous pedunculated myomaand broad ligament myoma, one each.Solitary myomas were 29 and multiple myomas were 8; a case each of broad ligament and cervical myoma(1), was later removed vaginally. Rests had abdominal procedure and was facilitated by Bonney's hoodincision and posterior incision 8 each, anterior 7, fundal 2, using multiple incision technique in 11 alongwith secondary tunneling incision (3). Uterine cavity was opened in 3 resulting in blood loss up to ≥ 500mlin 2. Degeneration were noticed in 11 [cystic (4), fatty (2), calcification (2) red (2) and myxoid (1)] and nonewith post operative morbidity. Pregnancies were recorded in 3 cases.Conclusion: Open abdominal myomectomy, for uterine myoma/s has been a recognized procedure forinfertile women in the past; but in view of less morbidity as shown by this present study myomectomy can besafely practiced in women desiring uterine preservation besides infertility care. .Key words: Degeneration; dysmenorrhoea; menorrhagia; myomectomyDOI: 10.3126/njog.v4i1.3326Nepal Journal of Obstetrics and Gynaecology June-July 2009; 4(1): 15-18