Abdominal myomectomy: results of a simple operative technique.

OBJECTIVES: To report a simple and safe procedure of abdominal myomectomy and our results performing this technique.

DESIGN: The operative technique comprises the incision on the most prominent part of the myoma, the use of a hooked clamp to hold the tumor, and a surgical knife to peel it, without removing the apparent excess of myometrium or serosa.

SETTING: University Medical Centers and private practice.

PATIENTS: Eighty patients, 9 of whom were operated between 10 and 26 weeks of pregnancy, 3 during cesarean section, and 22 others who had infertility.

RESULTS: Myomectomy was performed successfully in all patients for whom it was scheduled. Eight of nine pregnant patients had successful deliveries at term. The cumulative 10-year reoccurrence and reoperation rates of life-table analysis were 38% and 18%, respectively. The cumulative conception rates were 100% for otherwise unexplained infertility at 2 years, and 63% and 79% at 5 years for all infertile and all patients attempting conception after myomectomy, respectively. An age > 30 years, infertility > 3 years, and multiple fibroids negatively affected these rates, whereas the use of an absorbable adhesion barrier (Interceed; Johnson & Johnson AB, Somerville, NJ) had a positive effect.

CONCLUSIONS: This procedure is an appropriate alternative for most women who want to preserve or enhance fertility potential, and if necessary, for pregnant women.