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Re: Adenomyoma From: Mats Bergstrom (matsb@sos.sll.se) Sat Jun 1 16:43:52 1996 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: OBDocRick@aol.com: "Re: vaginal breech" Previous message: Rjshar@aol.com: "Re: physician on call scheduling software" In reply to: dahmd@gate.net: "Re: Adenomyoma" Ashley Hill wrote (in answer to Ronald Helms): > I'm a little confused about your statement regarding intramural > fibroids. Do you mean that you would not do a laparoscopic or > abdominal myomectomy on a 24 year old nulligravid woman with pelvic > pressure, severe constipation, and a *solitary* 8cm posterior fundal > intramural fibroid with an otherwise normal workup? If not, could > you please elaborate on why not? I just did one with great results > and the patient is thrilled that she gets to keep her uterus! When fibroids are causing significant symptoms, there is not much controversy, neither so when fibroids are associated with infertility. Gehlbach et al - Int J Gyn Ob 1993;40(1):45-50 - performed abdominal myomectomy on 37 infertile women. 57% subsequently conceived. 19 of the 37 patients had abdominal surgery at a later date, for various reasons. 13 (68%) of them had pelvic adhesions. Tulandi et al - Ob Gyn 1993;82(2)213-5 - performed abdominal myomectomy on 26 infertile women with a large leiomyomatous uterus, and did a second-look laparoscopy 6 weeks later. 66% conceived within 1 year. At the second-look, adnexal adhesions were found in 93% of patients whith a posterior wall incision compared to 21% with a fundal or anterior wall incision. The severity of the adhesions was also related to the location of the fibroids, 22 points for posterior incisions versus 3 points for fundal/anterior incisions as graded by the American Fertility Society classification. Hasson et al - Ob Gyn 1992;80(5):884-8 - performed laparoscopic myomectomy on 56 women (17 with infertility, 32 with pain and/or bleeding problems, 7 with a pelvic mass). 24 women underwent second-look laparoscopy. 66% of these had adhesions. 12 of the 17 infertile women subsequently conceived. So, despite the high rate of postoperative adhesions, most infertile women with leiomyoma do conceive after myomectomy. The controversy would be how to manage young women who are lacking significant symptoms and with no prior history of infertility. Probably such women should be managed expectantly, allowing them to try to conceive before possible surgery. It's an old 'truth' that non-submucous fibroids rarely cause infertility (but prospective studies seem hard to find) and postoperative adhesions, at least theoretically (also here hard data seem to be lacking), might be a hasard to the fecundity of these women. -- Mats Bergstrom, MD Ob Gyn South Hospital Stockholm Next message: OBDocRick@aol.com: "Re: vaginal breech" Previous message: Rjshar@aol.com: "Re: physician on call scheduling software" In reply to: dahmd@gate.net: "Re: Adenomyoma"

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