Campo, Sebastiano; Campo, Vincenzo; Gambadauro, Pietro
Obstetrical & Gynecological Survey. 60(12):795-796, December 2005.
This is a summary (with editorial comment) of an article that we had previously published on Acta Obstetricia et Gynecologica Scadinavica (read more). Abstract:
This paper presents data from a series of 80 premenopausal women who underwent resectoscopic myomectomy. Forty-two patients underwent myomectomy during the first few days of their menses (group A), and 38 were operated on after pretreatment with a GnRH analog consisting of 2 months of intramuscular triptorelin (3.75 mg Decapeptyl; group B). Pretreatment or no pretreatment was the decision of the managing gynecologist.
A 9-mm, rigid, zero-degree resectoscope with a loop electrode (Stortz, Germany) was used to perform the myomectomies. Distension of the uterine cavity was achieved using a sorbitol-mannitol solution at a pressure of 80 to 120 mm Hg. The fluid balance was kept above -1500 mL.
The Wamsteker classification system (type 0: completely intracavitary, type 1: intramural extension of <50%, type 2: intramural extension >=50%) was used to classify myomas. Follow-up examinations and ultrasounds were performed at 6, 12, and 24 months after myomectomy.
The mean age of all patients was 39 years and did not differ between treatment groups. Sixty-six percent of group A and 68% of group B had previous pregnancies. Seventy-nine percent of each group presented with abnormal uterine bleeding (n = 33 in group A and 30 in group B; total = 63).
A total of 90 myomas were removed from the 42 women in group A and from the 38 women in group B. Thus, in each group, an average of 1.1 myomas were removed per patient. Similarly, there were no differences between groups in mean diameter of the myomas (28 mm and 29 mm, respectively), the type of myoma (type 0-n = 16 and 15, type 1-23 and 20, and type 2-9 and 7, respectively), or the association with uterine polyps (n = 7 for both).
Mean operating time was significantly longer in the pretreated group compared with no pretreatment (40 minutes in group A vs 58 minutes in group B, P = .002), but the average length of hospital stay was similar (1.05 days and 1.15 days, respectively).
One woman in group B sustained an intraoperative perforation, which was repaired immediately with no long-term consequences. This was the only intraoperative complication in either group of patients. Six patients (3 in each group) had a cellular leiomyoma without atypia.
With 24 months of follow up, 12 of 33 (36.3%) women in group A and 8 of 30 (26.6%) in group B had a recurrence of abnormal uterine bleeding (P = 0.57, not significant). A total of 5 women (6.2%) had recurrent myomas.
Full text+comment available at: