ABSTRACT
BACKGROUND: Abdominal myomectomy remains the mainstay of surgical management of uterine fibroids in our environment. However, its benefit in women aged 40 years and above remains debatable. MATERIALS AND METHODS: An 11-year prospective study was conducted involving 98 women, aged 40 years and above, who had abdominal myomectomy for the treatment of uterine fibroid at the University of Maiduguri Teaching Hospital, Maiduguri. They were followed up regularly for 1-6 years to detect conception, resolution of symptoms and obstetrics performance. Data were analyzed using SPSS version 13. RESULTS: The mean age of the patients was 42.6±2.9 years and 77 (78.6%) of them were nulliparous. Lower abdominal swelling was the commonest clinical presentation and the mean uterine size was 18.6±8.5 weeks. Infertility with uterine fibroids was the indication for myomectomy in majority of the cases [48 (48.9%)], while pregnancy complications accounted for 11.2% (11) of the cases Fertility restoration was 10.4% among the infertile patients. There was complete resolution of symptoms in 35.9% of those who required symptomatic relief, and term pregnancies were recorded in 72.7% of patients with pregnancy complications. CONCLUSION: Myomectomy is the recommended treatment of uterine fibroids in women aged 40 years and above with infertility and who wish to become pregnant. If there is no need for further fertility preservation, hysterectomy should be offered.
ABSTRACT
PURPOSE: To determine the recurrence rate and risk factors for recurrence following myomectomy. METHODS: Two hundred and thirty-two women who had open myomectomy were followed up for 3-10 years. Clinical features as well as pelvic ultrasound scan were used to evaluate the patients for recurrence. Recurrence rate was computed and the risk factors for recurrence were determined using Odd ratio comparing the Sociodemographic characteristics, preoperative symptoms, surgical and pathologic findings in the two groups of patients. RESULTS: The mean age and parity of the patients were 29.3 ± 3.8 years and 1.2 ± 1.1, respectively. The desire for procreation after surgery was noted in 183 (78.9%) of the patients while the rest desired resolution of symptoms. More than half of the patients had multiple symptoms. Intraoperatively, 63 (7.2%) had single fibroid removed while the rest were multiple varying from 2 to 67 pieces. The overall recurrence rate during the follow-up period was 20.7% (48/232) at 10 years and this increases with time. Positive family history of uterine fibroids, multiple uterine fibroids, and persistence or recurrence of three or more of the pre-myomectomy symptoms were significantly associated with the recurrence of uterine fibroids (OR = 21.83, 3.14, and 3.49, respectively) while pregnancy after myomectomy and the use of oral contraceptive pills (OCP) were protective. CONCLUSION: There is a high recurrence of uterine fibroid after myomectomy in our environment. The risk is higher among women with positive family history, multiple uterine fibroids, and in those with multiple symptoms. Pregnancy and use of OCP are protective.
