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
@#Ectopic pregnancy is one of the leading causes of maternal morbidity and mortality worldwide, as seen in 9 to 13% and up to 30% of maternal deaths in developed and developing countries, respectively. Bilateral tubal pregnancy is an exceedingly rare condition with an even greater risk of rupture and hemorrhage than that of the unilateral type. This is a case of a 32 yearold G4P3 (4004) who presented with amenorrhea of 5 weeks, vaginal bleeding, and abdominal pain. The triad of symptoms, elevated serum β-HCG levels, along with a transvaginal ultrasound finding of a right adnexal mass led to the impression of a ruptured ectopic pregnancy, probably tubal. Patient underwent laparoscopy and intraoperative findings revealed bilateral tubal pregnancy for which bilateral salpingectomy was done. Oftentimes, as in this case, bilateral tubal pregnancy is diagnosed intraoperatively. However, it is possible, as seen in a review of cases, that a combination of history, symptoms, and clinical findings may point to a probable diagnosis which is imperative in treatment planning. Bilateral tubal pregnancy is rare, but due to a rise in pelvic inflammatory disease, its consequences, and the advent of assisted reproductive techniques, the risk for this condition increases with important clinical implications.