Myomectomy - Indications and Complications

This is part of the Gynsurgery guidelines used in an educational setting for residents in Ob-Gyn.

Indications for myomectomy

 * 1) Infertility/pregnancy loss
 * 2) History of one or more pregnancy losses or 1 year infertility and evidence of fibroid impingment on uterine cavity or near tubal ostia
 * 3) Pelvic Pain
 * 4) Urinary pressure, voiding difficulty or frequency and anterior fibroid
 * 5) Dysmenorrhea and evidence of multiple fibroids
 * 6) Low back pain and posterior fibroids greater than 6 cm diameter cumulative
 * 7) Dyspareunia and fibroids impinging upon cervix or posterior cul de sac
 * 8) Enlarging fibioids
 * 9) Enlarging uterine mass producing worry for a possible sarcoma
 * 10) Enlarging post menopausal fibroid

Complications

 * 1) Hemorrhage
 * 2) Infection/abscess
 * 3) Too much damage to functional ovarian tissue or tube
 * 4)  Premature menopause
 * 5)  Decreased fertility
 * 6)  Ectopic pregnancy
 * 7) Spreading unanticipated malignancy
 * 8) Spillage of caustic/irritant material (18%)
 * 9) Recurrence of ovarian cyst
 * 10) Bladder injury
 * 11) Ureteral injury
 * 12) Persistent pain
 * 13)  Ovarian remnant syndrome
 * 14)  Residual scarring causing pelvic pain
 * 15) Ovarian vein thrombosis

Prevention of Complications

 * 1) Hemorrhage
 * 2) close dead space in ovary
 * 3) avoid hilum of ovary
 * 4) Infection/abscess
 * 5) close dead space in ovary
 * 6) avoid ovarian tissue necrosis
 * 7) avoid extensive cautery (use pinpoint if needed)
 * 8) Too much damage to functional ovarian tissue or tube
 * 9)  Premature menopause
 * 10) identify any remaining normal germinal epithelium
 * 11) use cautery/coagulation instruments that limit lateral spread
 * 12) avoid ovarian hilum (compromising the blood supply)
 * 13)  Decreased fertility
 * 14) identify any remaining normal germinal epithelium
 * 15) use cautery/coagulation instruments that limit lateral spread
 * 16) avoid ovarian hilum (compromising the blood supply)
 * 17)  Ectopic pregnancy
 * 18) use cautery/coagulation instruments that limit lateral spread
 * 19) Spreading unanticipated malignancy
 * 20) use bag
 * 21) avoid capsule rupture
 * 22) decompress using suture around sucker
 * 23) Spillage of caustic/irritant material (18%)
 * 24) use bag
 * 25) avoid capsule rupture
 * 26) decompress using suture around sucker
 * 27) Recurrence of ovarian cyst
 * 28) avoid aspiration only of ovarian cyst
 * 29) perform cystectomy for endometriosis not just cautery
 * 30) suppress medically postoperatively
 * 31) Bladder injusry
 * 32) identify blsdder limits if ovarian adhesions anywhere near the bladder
 * 33) Ureteral injury
 * 34) identify ureter in broad ligament if ovarian adhesions to broad ligament
 * 35) Persistent pain
 * 36) Ovarian remnant syndrome
 * 37) Identify entire ovary
 * 38) Residual scarring causing pain
 * 39) Minimize any necrotic tissue
 * 40) Ovarian vein thrombosis
 * 41) avoid injury to ovarian vessels (IP ligament)