ABSTRACT
Background@#Uterine fibroids are the most common benign tumors in women. Management of symptomatic fibroids may ultimately require surgery and for those desirous of fertility, laparoscopically assisted myomectomy and the conventional laparoscopic procedure are conservative treatment options, with the former providing a less technically demanding approach.@*Objectives@#This study aims to evaluate the clinical outcomes for laparoscopically assisted myomectomy (LAM) versus laparoscopic myomectomy (LM) done at a tertiary hospital.@*Methods@#This is a retrospective chart review of 118 patients with symptomatic myomas who underwent LM (n=66) or LAM (n=52) at a tertiary hospital from January 2010 to December 2017.@*Results@#There were significantly more fibroids removed in the LAM group compared to the LM group, but with no significant difference in the average diameter of fibroid removed. Complex plastic reconstruction with more than 2 layers of repair was done more often in the LAM group (p<0.001). The mean operative time was longer and more blood loss was incurred in the LM group, but this was not statistically significant. Almost 14% of patients in the LM group had blood transfusion compared to 4.1% in the LAM group (p=0.085). The rate of perioperative complications was similar for both groups. The length of hospital stay was shorter in the LM group, but was not statistically significant. A trend towards higher odds of pregnancy was seen in the LAM group. Majority of patients were delivered via cesarean section with no incidence of uterine rupture. The recurrence of fibroids was seen more in the LAM group (17.9% versus 13.7% for LM), however this was not statistically significant.@* Conclusions@#The surgical, reproductive, and long-term clinical outcomes for both LAM and LM are similar, thus, LAM provides a non-inferior minimally invasive approach and a conservative option for patients desirous of future fertility.
Subject(s)
Uterine Myomectomy , LaparoscopyABSTRACT
@#This commentary is focused primarily on the relationship between menopausal hormone therapy (MHT) and breast cancer risk, the primary adverse outcome measure of the Women’s Health Initiative (WHI) hormone trials. The WHI hormone trials are to date the largest randomized, placebo-controlled studies that evaluated the risks and benefits of hormone therapy in postmenopausal women. There are two arms: the estrogen-progestin (conjugated equine estrogen/medroxyprogesterone acetate) arm for women with intact uterus and the estrogen-alone (conjugated equine estrogen) arm for women who had a hysterectomy1. Both arms, planned to continue for 8.5 years, were stopped prematurely, the CEE/MPA arm after a mean of 5.2 years of follow-up and the CEE-alone arm after a mean of 7.2 years follow-up.
Subject(s)
Female , Estrogens, Conjugated (USP) , Medroxyprogesterone AcetateABSTRACT
@#Mullerian duct anomalies (MDAs) are congenital defects of the female genital system that arise from abnormal embryological development of the Mullerian ducts. A didelphys uterus, also known as a "double uterus," is one of the least common amongst the MDAs. Reported here is a case of a 16 year old female with a uterus didelphys with the obstructed left hemiuteri adherent in the anterior abdominal wall, and an endometriotic cyst on the same side. She underwent hysteroscopy-guided vaginoscopy, laparoscopic left hemihysterectomy, left oophorocystectomy. Cases such as these require careful preoperative planning and diagnostic imaging for more accurate diagnosis and, hence, for the most appropriate surgical procedure to be carried out. 3D ultrasonography and Magnetic Resonance Imaging have been the most widely used imaging techniques. The goals of management are to relieve the symptoms of obstruction and to restore the normal anatomy as much as possible in order to provide the best chance for future fertility.