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Abdominal myomectomy

Author
William H Parker, MD
Section Editor
Howard T Sharp, MD
Deputy Editor
Sandy J Falk, MD, FACOG

INTRODUCTION

Uterine leiomyomas (fibroids or myomas) are the most common type of pelvic tumor in women, with an approximately 70 to 80 percent lifetime risk [1-3]. There are many management options for fibroid-related symptoms, including expectant management, medical therapy, non-excisional procedures (endometrial ablation, uterine artery embolization, magnetic resonance guided focused ultrasound), and surgery (myomectomy, hysterectomy).

Abdominal myomectomy (performed via laparotomy; also referred to as open myomectomy) was developed in the early 1900s as a conservative treatment for women with uterine myomas. Myomectomy is the surgical removal of leiomyomas from the uterus, leaving the uterus in place. This can be accomplished using an abdominal, laparoscopic, hysteroscopic, or vaginal approach.

Abdominal myomectomy will be reviewed here. General principles of the treatment of uterine leiomyomas, as well as laparoscopic, hysteroscopic, and vaginal myomectomy and techniques to reduce blood loss during myomectomy, are discussed separately. (See "Overview of treatment of uterine leiomyomas (fibroids)" and "Laparoscopic myomectomy and other laparoscopic treatments for uterine leiomyomas (fibroids)" and "Hysteroscopic myomectomy" and "Prolapsed uterine leiomyoma (fibroid)" and "Techniques to reduce blood loss during abdominal or laparoscopic myomectomy".)

PATIENT SELECTION

Abdominal myomectomy is performed mostly for women with intramural or subserosal leiomyomas (figure 1). Intracavitary myomas (submucosal and some intramural myomas that protrude into the endometrial cavity) (figure 2) may also be removed during abdominal myomectomy. However, hysteroscopic myomectomy is the procedure of choice when only intracavitary myomas are removed, since it offers the advantages of a faster recovery and less perioperative morbidity. (See "Hysteroscopic myomectomy", section on 'Patient selection'.)

Appropriate candidates for abdominal myomectomy are women with the following characteristics:

                                                      

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Literature review current through: Nov 2016. | This topic last updated: Thu Jan 21 00:00:00 GMT 2016.
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References
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