Abdominal myomectomy versus abdominal hysterectomy for symptomatic and big uterine fibroids

OBJECTIVE: To compare abdominal myomectomy with abdominal hysterectomy in women with big and symptomatic uterine fibroids.

METHODS: The hospital records at King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia were reviewed to identify women who underwent abdominal myomectomy or abdominal hysterectomy between 1989 and 1999. Inclusion criteria were the presence of symptoms and size of the uterus equaling that of 12 weeks gestation or more. Women who underwent myomectomy as a treatment of infertility were excluded.

RESULTS: During the study period, 111 women met the inclusion criteria. Thirty-eight women underwent abdominal myomectomy and 73 women underwent abdominal hysterectomy. Forty women were excluded because of myomectomy for infertility. Abdominal myomectomy was successfully performed in all women for whom it was scheduled. Hysterectomy, internal iliac ligation, or other procedures were not necessary to control the bleeding. The primary indication for myomectomy was abnormal vaginal bleeding in 23 women and pelviabdominal mass in 15 women compared to 6 women and 67 women in the hysterectomy group. There were statistically significant differences in the mean age and parity (p value 0.01 and <0.001) between women who underwent abdominal myomectomy and abdominal hysterectomy. The uterine size clinically (mean ± standard deviation), size of largest myoma by ultrasonography, and from histopathology reports were 15.4 ± 3.8, 11.8 ± 2.8, and 13.6 ± 3.2 compared to 17.9 ± 4.4, 16.9 ± 4.2, and 13.8 ± 3.7 (p values not statistically significant). Similarly, there were no statistically significant differences in the pre- and postoperative hemoglobin, estimated blood loss, rate of blood transfusion, operative time, and numbers of days in hospital.

CONCLUSION: Abdominal myomectomy for big and symptomatic uterine fibroids carries similar risks to abdominal hysterectomy.