Myomectomy: Results and Complications

  • Ioannis Tsimpanakos
  • Adam Magos
Part of the Medical Radiology book series (MEDRAD)


Uterine fibroids are common hormone sensitive benign tumours of the uterus, with a reported incidence of up to 30–40 % in women of reproductive age with variations depending on the age group and ethnic background. Although they are asymptomatic in many cases, the presence and persistence of clinical symptoms warrants medical or surgical intervention. Myomectomy is advisable for symptomatic women who want to preserve their uterus. Myomectomy can be performed trans-abdominally, laparoscopically, vaginally or hysteroscopically. The aim of this intervention is to alleviate any menstrual symptoms and improve fertility. Whatever the route of surgery, however, myomectomy is classified as a major operation which is associated with both short- and long-term complications which, in many respects, depend on the size, location and number of fibroids. Apart from risks such as infection, bruising, deep vein thrombosis, which apply to any major surgical procedure, complications range from major intra-operative blood loss, occasionally necessitating hysterectomy, to longer term problems of post-operative adhesions and fibroid recurrence. There are also route-specific potential complications related to the type of myomectomy.


Uterine Cavity Uterine Fibroid Uterine Rupture GnRH Analogue Abnormal Uterine Bleeding 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Agostini A, Deval B, Birsan A, Ronda I, Bretelle F, Roger V, Cravello L, Madelenat P, Blanc B (2004) Vaginal myomectomy using posterior colpotomy: feasibility in normal practice. Eur J Obstet Gynecol Reprod Biol 116:217–220PubMedCrossRefGoogle Scholar
  2. Agostini A, Gerbeau S, Al NM, Ronda I, Cravello L, Blanc B (2008) Complications of vaginal myomectomy by posterior colpotomy. Eur J Obstet Gynecol Reprod Biol 138:100–104PubMedCrossRefGoogle Scholar
  3. Amico P, Caltabiano R, Zizza G, Lanzafame S (2010) About a case of diffuse endometrial squamous metaplasia after resectoscopic myomectomy: a potential diagnostic pitfall for gynecologists and pathologists. Appl Immunohistochem Mol Morphol 18:392–395PubMedCrossRefGoogle Scholar
  4. Ben-Baruch G, Schiff E, Menashe Y, Menczer J (1988) Immediate and late outcome of vaginal myomectomy for prolapsed pedunculated submucous myoma. Obstet Gynecol 72:858–861PubMedGoogle Scholar
  5. Bernard G, Darai E, Poncelet C, Benifla JL, Madelenat P (2000) Fertility after hysteroscopic myomectomy: effect of intramural myomas associated. Eur J Obstet Gynecol Reprod Biol 88:85–90PubMedCrossRefGoogle Scholar
  6. Birsan A, Deval B, Detchev R, Poncelet C, Darai E (2003) Vaginal and laparoscopic myomectomy for large posterior myomas: results of a pilot study. Eur J Obstet Gynecol Reprod Biol 110:89–93PubMedCrossRefGoogle Scholar
  7. Buttram VC Jr, Reiter RC (1981) Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril 36:433–445PubMedGoogle Scholar
  8. Chapman L, Magos A (2006) Surgical and radiological management of uterine fibroids in the UK. Curr Opin Obstet Gynecol 18:394–401PubMedCrossRefGoogle Scholar
  9. Connolly G, Doyle M, Barrett T, Byrne P, De MM, Harrison RF (2000) Fertility after abdominal myomectomy. J Obstet Gynaecol 20:418–420PubMedCrossRefGoogle Scholar
  10. Cravello L, D’Ercole C, Azoulay P, Boubli L, Blanc B (1995) Hysteroscopic treatment of uterine fibromas. J Gynecol Obstet Biol Reprod (Paris) 24:374–380Google Scholar
  11. Cravello L, Agostini A, Beerli M, Roger V, Bretelle F, Blanc B (2004) Results of hysteroscopic myomectomy. Gynecol Obstet Fertil 32:825–828PubMedCrossRefGoogle Scholar
  12. Davies A, Hart R, Magos AL (1999) The excision of uterine fibroids by vaginal myomectomy: a prospective study. Fertil Steril 71:961–964PubMedCrossRefGoogle Scholar
  13. Di Spiezio SA, Mazzon I, Bramante S, Bettocchi S, Bifulco G, Guida M, Nappi C (2008) Hysteroscopic myomectomy: a comprehensive review of surgical techniques. Hum Reprod Update 14:101–119CrossRefGoogle Scholar
  14. Dubuisson JB (2000) Management of leiomyomata. Hum Reprod Update 6:587PubMedCrossRefGoogle Scholar
  15. Dubuisson JB, Chavet X, Chapron C, Gregorakis SS, Morice P (1995) Uterine rupture during pregnancy after laparoscopic myomectomy. Hum Reprod 10:1475–1477PubMedGoogle Scholar
  16. Dubuisson JB, Chapron C, Chavet X, Gregorakis SS (1996) Fertility after laparoscopic myomectomy of large intramural myomas: preliminary results. Hum Reprod 11:518–522PubMedCrossRefGoogle Scholar
  17. Dubuisson JB, Fauconnier A, Deffarges JV, Norgaard C, Kreiker G, Chapron C (2000) Pregnancy outcome and deliveries following laparoscopic myomectomy. Hum Reprod 15:869–873PubMedCrossRefGoogle Scholar
  18. Duron JJ (2007) Postoperative intraperitoneal adhesion pathophysiology. Colorectal Dis 9(Suppl 2):14–24PubMedCrossRefGoogle Scholar
  19. Emanuel MH, Wamsteker K, Hart AA, Metz G, Lammes FB (1999) Long-term results of hysteroscopic myomectomy for abnormal uterine bleeding. Obstet Gynecol 93:743–748PubMedCrossRefGoogle Scholar
  20. Faivre E, Surroca MM, Deffieux X, Pages F, Gervaise A, Fernandez H (2010) Vaginal myomectomy: literature review. J Minim Invasive Gynecol 17:154–160PubMedCrossRefGoogle Scholar
  21. Fauconnier A, Chapron C, Babaki-Fard K, Dubuisson JB (2000) Recurrence of leiomyomata after myomectomy. Hum Reprod Update 6:595–602PubMedCrossRefGoogle Scholar
  22. Fedele L, Vercellini P, Bianchi S, Brioschi D, Dorta M (1990) Treatment with GnRH agonists before myomectomy and the risk of short-term myoma recurrence. Br J Obstet Gynaecol 97:393–396PubMedCrossRefGoogle Scholar
  23. Frederick J, Hardie M, Reid M, Fletcher H, Wynter S, Frederick C (2002) Operative morbidity and reproductive outcome in secondary myomectomy: a prospective cohort study. Hum Reprod 17:2967–2971PubMedCrossRefGoogle Scholar
  24. Gambadauro P, Gudmundsson J, Torrejon R (2012) Intrauterine adhesions following conservative treatment of uterine fibroids. Obstet Gynecol Int 2012:853269PubMedCentralPubMedGoogle Scholar
  25. Hanafi M (2005) Predictors of leiomyoma recurrence after myomectomy. Obstet Gynecol 105:877–881PubMedCrossRefGoogle Scholar
  26. Ismail SI, Bennett SJ (2009) Vaginal delivery after myomectomy: challenges and opportunities. Arch Gynecol Obstet 280:669–670PubMedCrossRefGoogle Scholar
  27. Ito M, Nawa T, Mikamo H, Tamaya T (1998) Lower segment uterine rupture related to early pregnancy by in vitro fertilization and embryo transfer after a previous cesarean delivery. J Med 29:85–91PubMedGoogle Scholar
  28. Iverson RE Jr, Chelmow D, Strohbehn K, Waldman L, Evantash EG (1996) Relative morbidity of abdominal hysterectomy and myomectomy for management of uterine leiomyomas. Obstet Gynecol 88:415–419PubMedCrossRefGoogle Scholar
  29. Iverson RE Jr, Chelmow D, Strohbehn K, Waldman L, Evantash EG, Aronson MP (1999) Myomectomy fever: testing the dogma. Fertil Steril 72:104–108PubMedCrossRefGoogle Scholar
  30. Jun SH, Ginsburg ES, Racowsky C, Wise LA, Hornstein MD (2001) Uterine leiomyomas and their effect on in vitro fertilization outcome: a retrospective study. J Assist Reprod Genet 18:139–143PubMedCentralPubMedCrossRefGoogle Scholar
  31. Kelly BA, Bright P, Mackenzie IZ (2008) Does the surgical approach used for myomectomy influence the morbidity in subsequent pregnancy? J Obstet Gynaecol 28:77–81PubMedCrossRefGoogle Scholar
  32. Landi S, Zaccoletti R, Ferrari L, Minelli L (2001) Laparoscopic myomectomy: technique, complications, and ultrasound scan evaluations. J Am Assoc Gynecol Laparosc 8:231–240PubMedCrossRefGoogle Scholar
  33. Liakakos T, Thomakos N, Fine PM, Dervenis C, Young RL (2001) Peritoneal adhesions: etiology, pathophysiology, and clinical significance. Recent advances in prevention and management. Dig Surg 18:260–273PubMedCrossRefGoogle Scholar
  34. Luijendijk RW, Jeekel J, Storm RK, Schutte PJ, Hop WC, Drogendijk AC, Huikeshoven FJ (1997) The low transverse Pfannenstiel incision and the prevalence of incisional hernia and nerve entrapment. Ann Surg 225:365–369PubMedCentralPubMedCrossRefGoogle Scholar
  35. Magos AL, Bournas N, Sinha R, Richardson RE, O’Connor H (1994) Vaginal myomectomy. Br J Obstet Gynaecol 101:1092–1094PubMedCrossRefGoogle Scholar
  36. Mais V, Ajossa S, Guerriero S, Mascia M, Solla E, Melis GB (1996) Laparoscopic versus abdominal myomectomy: a prospective, randomized trial to evaluate benefits in early outcome. Am J Obstet Gynecol 174:654–658PubMedCrossRefGoogle Scholar
  37. Metwally M, Watson A, Lilford R, Vandekerckhove P (2006) Fluid and pharmacological agents for adhesion prevention after gynaecological surgery. Cochrane Database Syst Rev 19(2):CD001298Google Scholar
  38. Mukhopadhaya N, De SC, Manyonda IT (2008) Conventional myomectomy. Best Pract Res Clin Obstet Gynaecol 22:677–705PubMedCrossRefGoogle Scholar
  39. Murakami T, Tamura M, Ozawa Y, Suzuki H, Terada Y, Okamura K (2005) Safe techniques in surgery for hysteroscopic myomectomy. J Obstet Gynaecol Res 31:216–223PubMedCrossRefGoogle Scholar
  40. Nezhat CH, Nezhat F, Roemisch M, Seidman DS, Tazuke SI, Nezhat CR (1999) Pregnancy following laparoscopic myomectomy: preliminary results. Hum Reprod 14:1219–1221PubMedCrossRefGoogle Scholar
  41. Olufowobi O, Sharif K, Papaionnou S, Neelakantan D, Mohammed H, Afnan M (2004) Are the anticipated benefits of myomectomy achieved in women of reproductive age? A 5-year review of the results at a UK tertiary hospital. J Obstet Gynaecol 24:434–440PubMedCrossRefGoogle Scholar
  42. Pelosi MA III, Pelosi MA (1997) Spontaneous uterine rupture at thirty-three weeks subsequent to previous superficial laparoscopic myomectomy. Am J Obstet Gynecol 177:1547–1549PubMedCrossRefGoogle Scholar
  43. Plotti G, Plotti F, Di GA, Battaglia F, Nagar G (2008) Feasibility and safety of vaginal myomectomy: a prospective pilot study. J Minim Invasive Gynecol 15:166–171PubMedCrossRefGoogle Scholar
  44. Polena V, Mergui JL, Perrot N, Poncelet C, Barranger E, Uzan S (2007) Long-term results of hysteroscopic myomectomy in 235 patients. Eur J Obstet Gynecol Reprod Biol 130:232–237PubMedCrossRefGoogle Scholar
  45. Pritts EA, Parker WH, Olive DL (2009) Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril 91:1215–1223PubMedCrossRefGoogle Scholar
  46. Ribeiro SC, Reich H, Rosenberg J, Guglielminetti E, Vidali A (1999) Laparoscopic myomectomy and pregnancy outcome in infertile patients. Fertil Steril 71:571–574PubMedCrossRefGoogle Scholar
  47. Rossetti A, Sizzi O, Soranna L, Cucinelli F, Mancuso S, Lanzone A (2001) Long-term results of laparoscopic myomectomy: recurrence rate in comparison with abdominal myomectomy. Hum Reprod 16:770–774PubMedCrossRefGoogle Scholar
  48. Roth TM, Gustilo-Ashby T, Barber MD, Myers ER (2003) Effects of race and clinical factors on short-term outcomes of abdominal myomectomy. Obstet Gynecol 101:881–884PubMedCrossRefGoogle Scholar
  49. Rovio PH, Heinonen PK (2006) Transvaginal myomectomy with screw traction by colpotomy. Arch Gynecol Obstet 273:211–215PubMedCrossRefGoogle Scholar
  50. Savage A, Lamont PM (2000) Wound dehiscence, incisional hernia and parastomal hernia. In: Morris PJ, Wood WC (eds) Oxford Textbook of Surgery, 2nd edn. Oxford Univ Press, pp 1883–1888Google Scholar
  51. Seinera P, Farina C, Todros T (2000) Laparoscopic myomectomy and subsequent pregnancy: results in 54 patients. Hum Reprod 15:1993–1996PubMedCrossRefGoogle Scholar
  52. Seracchioli R, Rossi S, Govoni F, Rossi E, Venturoli S, Bulletti C, Flamigni C (2000) Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy. Hum Reprod 15:2663–2668PubMedCrossRefGoogle Scholar
  53. Sizzi O, Rossetti A, Malzoni M, Minelli L, La GF, Soranna L, Panunzi S, Spagnolo R, Imperato F, Landi S, Fiaccamento A, Stola E (2007) Italian multicenter study on complications of laparoscopic myomectomy. J Minim Invasive Gynecol 14:453–462PubMedCrossRefGoogle Scholar
  54. Stewart EA (2001) Uterine fibroids. Lancet 357:293–298PubMedCrossRefGoogle Scholar
  55. Sudik R, Husch K, Steller J, Daume E (1996) Fertility and pregnancy outcome after myomectomy in sterility patients. Eur J Obstet Gynecol Reprod Biol 65:209–214PubMedCrossRefGoogle Scholar
  56. Surrey ES, Lietz AK, Schoolcraft WB (2001) Impact of intramural leiomyomata in patients with a normal endometrial cavity on in vitro fertilization-embryo transfer cycle outcome. Fertil Steril 75:405–410PubMedCrossRefGoogle Scholar
  57. Surrey ES, Minjarez DA, Stevens JM, Schoolcraft WB (2005) Effect of myomectomy on the outcome of assisted reproductive technologies. Fertil Steril 83:1473–1479PubMedCrossRefGoogle Scholar
  58. Swank DJ, van Erp WF, Repelaer van Driel OJ, Hop WC, Bonjer HJ, Jeekel J (2002) Complications and feasibility of laparoscopic adhesiolysis in patients with chronic abdominal pain. A retrospective study. Surg Endosc 16:1468–1473PubMedCrossRefGoogle Scholar
  59. Taskin O, Sadik S, Onoglu A, Gokdeniz R, Erturan E, Burak F, Wheeler JM (2000) Role of endometrial suppression on the frequency of intrauterine adhesions after resectoscopic surgery. J Am Assoc Gynecol Laparosc 7:351–354PubMedCrossRefGoogle Scholar
  60. Taylor A, Sharma M, Tsirkas P, Di Spiezio SA, Setchell M, Magos A (2005) Reducing blood loss at open myomectomy using triple tourniquets: a randomised controlled trial. BJOG 112:340–345PubMedCrossRefGoogle Scholar
  61. Thomas B, Magos A (2011) Subtotal hysterectomy and myomectomy—vaginally. Best Pract Res Clin Obstet Gynaecol 25:133–152PubMedCrossRefGoogle Scholar
  62. Thompson LB, Reed SD, McCrummen BK, Warolin AK, Newton KM (2006) Leiomyoma characteristics and risk of subsequent surgery after myomectomy. Int J Gynaecol Obstet 95:138–143PubMedCrossRefGoogle Scholar
  63. Tulandi T, Murray C, Guralnick M (1993) Adhesion formation and reproductive outcome after myomectomy and second-look laparoscopy. Obstet Gynecol 82:213–215PubMedGoogle Scholar
  64. van der Wal JB, Iordens GI, Vrijland WW, van Veen RN, Lange J, Jeekel J (2011) Adhesion prevention during laparotomy: long-term follow-up of a randomized clinical trial. Ann Surg 253:1118–1121PubMedCrossRefGoogle Scholar
  65. Verkauf BS (1992) Myomectomy for fertility enhancement and preservation. Fertil Steril 58:1–15PubMedGoogle Scholar
  66. West S, Ruiz R, Parker WH (2006) Abdominal myomectomy in women with very large uterine size. Fertil Steril 85:36–39PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.University Department of Obstetrics and GynaecologyRoyal Free HospitalLondonUK

Personalised recommendations