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Abdominal myomectomy

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


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".)


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 2017. | This topic last updated: Jan 21, 2016.
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  1. Baird DD, Dunson DB, Hill MC, et al. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 2003; 188:100.
  2. Buttram VC Jr, Reiter RC. Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril 1981; 36:433.
  3. Serden SP, Brooks PG. Treatment of abnormal uterine bleeding with the gynecologic resectoscope. J Reprod Med 1991; 36:697.
  4. McLucas B, Chespak L, Kaminsky D. Myoma necrosis following Gelfoam embolization of uterine myomata. Minim Invasive Ther Allied Technol 2008; 17:200.
  5. Reiter RC, Wagner PL, Gambone JC. Routine hysterectomy for large asymptomatic uterine leiomyomata: a reappraisal. Obstet Gynecol 1992; 79:481.
  6. Pritts EA, Parker WH, Olive DL. Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril 2009; 91:1215.
  7. Klatsky PC, Tran ND, Caughey AB, Fujimoto VY. Fibroids and reproductive outcomes: a systematic literature review from conception to delivery. Am J Obstet Gynecol 2008; 198:357.
  8. Mara M, Maskova J, Fucikova Z, et al. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc Intervent Radiol 2008; 31:73.
  9. Broder MS, Goodwin S, Chen G, et al. Comparison of long-term outcomes of myomectomy and uterine artery embolization. Obstet Gynecol 2002; 100:864.
  10. Thompson LB, Reed SD, McCrummen BK, et al. Leiomyoma characteristics and risk of subsequent surgery after myomectomy. Int J Gynaecol Obstet 2006; 95:138.
  11. Stewart EA, Faur AV, Wise LA, et al. Predictors of subsequent surgery for uterine leiomyomata after abdominal myomectomy. Obstet Gynecol 2002; 99:426.
  12. Viswanathan, M, Hartmann, K, McKoy, N, et al. Management of Uterine Fibroids: An Update of the Evidence. Evidence Report/Technology Assessment No. 154 AHRQ Publication No. 07-E011. Rockville, MD: Agency for Healthcare Research and Quality. July 2007. http://www.ahrq.gov/clinic/tp/uteruptp.htm (Accessed on November 12, 2010).
  13. Sawin SW, Pilevsky ND, Berlin JA, Barnhart KT. Comparability of perioperative morbidity between abdominal myomectomy and hysterectomy for women with uterine leiomyomas. Am J Obstet Gynecol 2000; 183:1448.
  14. Iverson RE Jr, Chelmow D, Strohbehn K, et al. Relative morbidity of abdominal hysterectomy and myomectomy for management of uterine leiomyomas. Obstet Gynecol 1996; 88:415.
  15. Dueholm M, Lundorf E, Hansen ES, et al. Accuracy of magnetic resonance imaging and transvaginal ultrasonography in the diagnosis, mapping, and measurement of uterine myomas. Am J Obstet Gynecol 2002; 186:409.
  16. Lethaby A, Vollenhoven B, Sowter M. Pre-operative GnRH analogue therapy before hysterectomy or myomectomy for uterine fibroids. Cochrane Database Syst Rev 2001; :CD000547.
  17. Brown SR, Goodfellow PB. Transverse verses midline incisions for abdominal surgery. Cochrane Database Syst Rev 2005; :CD005199.
  18. Bustos López HH, Miranda Rodríguez JA, Kably Ambe A, et al. [Preoperative management of uterine leiomyomatosis using pituitary gonadotropin-releasing hormone analogues]. Ginecol Obstet Mex 1995; 63:356.
  19. ACOG Committee on Practice Bulletins--Gynecology. ACOG practice bulletin No. 104: Antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol 2009; 113:1180. Reaffirmed 2016.
  20. Mukhopadhaya N, De Silva C, Manyonda IT. Conventional myomectomy. Best Pract Res Clin Obstet Gynaecol 2008; 22:677.
  21. Discepola F, Valenti DA, Reinhold C, Tulandi T. Analysis of arterial blood vessels surrounding the myoma: relevance to myomectomy. Obstet Gynecol 2007; 110:1301.
  22. Tulandi T, Murray C, Guralnick M. Adhesion formation and reproductive outcome after myomectomy and second-look laparoscopy. Obstet Gynecol 1993; 82:213.
  23. Guarnaccia MM, Rein MS. Traditional surgical approaches to uterine fibroids: abdominal myomectomy and hysterectomy. Clin Obstet Gynecol 2001; 44:385.
  24. West S, Ruiz R, Parker WH. Abdominal myomectomy in women with very large uterine size. Fertil Steril 2006; 85:36.
  25. Walocha JA, Litwin JA, Miodoński AJ. Vascular system of intramural leiomyomata revealed by corrosion casting and scanning electron microscopy. Hum Reprod 2003; 18:1088.
  26. LaMorte AI, Lalwani S, Diamond MP. Morbidity associated with abdominal myomectomy. Obstet Gynecol 1993; 82:897.
  27. Schüring AN, Garcia-Rocha GJ, Schlösser HW, et al. Perioperative complications in conventional and microsurgical abdominal myomectomy. Arch Gynecol Obstet 2011; 284:137.
  28. Olufowobi O, Sharif K, Papaionnou S, et al. 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 2004; 24:434.
  29. Rybak EA, Polotsky AJ, Woreta T, et al. Explained compared with unexplained fever in postoperative myomectomy and hysterectomy patients. Obstet Gynecol 2008; 111:1137.
  30. Dubuisson JB, Fauconnier A, Chapron C, et al. Second look after laparoscopic myomectomy. Hum Reprod 1998; 13:2102.
  31. Minig L, Trimble EL, Sarsotti C, et al. Building the evidence base for postoperative and postpartum advice. Obstet Gynecol 2009; 114:892.
  32. Ikpeze OC, Nwosu OB. Features of uterine fibroids treated by abdominal myomectomy at Nnewi, Nigeria. J Obstet Gynaecol 1998; 18:569.
  33. Sirjusingh A, Bassaw B, Roopnarinesingh S. The results of abdominal myomectomy. West Indian Med J 1994; 43:138.
  34. Vercellini P, Maddalena S, De Giorgi O, et al. Determinants of reproductive outcome after abdominal myomectomy for infertility. Fertil Steril 1999; 72:109.
  35. Fedele L, Parazzini F, Luchini L, et al. Recurrence of fibroids after myomectomy: a transvaginal ultrasonographic study. Hum Reprod 1995; 10:1795.
  36. Candiani GB, Fedele L, Parazzini F, Villa L. Risk of recurrence after myomectomy. Br J Obstet Gynaecol 1991; 98:385.
  37. Acién P, Quereda F. Abdominal myomectomy: results of a simple operative technique. Fertil Steril 1996; 65:41.
  38. Cramer SF, Patel A. The frequency of uterine leiomyomas. Am J Clin Pathol 1990; 94:435.
  39. Hanafi M. Predictors of leiomyoma recurrence after myomectomy. Obstet Gynecol 2005; 105:877.
  40. Malone LJ. Myomectomy: recurrence after removal of solitary and multiple myomas. Obstet Gynecol 1969; 34:200.
  41. Buttram VC Jr. Uterine leiomyomata--aetiology, symptomatology and management. Prog Clin Biol Res 1986; 225:275.
  42. Fauconnier A, Chapron C, Babaki-Fard K, Dubuisson JB. Recurrence of leiomyomata after myomectomy. Hum Reprod Update 2000; 6:595.
  43. Tsuji S, Takahashi K, Imaoka I, et al. MRI evaluation of the uterine structure after myomectomy. Gynecol Obstet Invest 2006; 61:106.
  44. Wallach EE, Vlahos NF. Uterine myomas: an overview of development, clinical features, and management. Obstet Gynecol 2004; 104:393.
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