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Re: GYN: fibroids/future fertilityFrom: Betty Rommel, MD, PhD (mszcynz@is2.nyu.edu)Fri Feb 27 14:07:31 1998
At Thu, 26 Feb 1998, Garry E. Siegel, M.D. wrote: > >Today, she had an irregular fibroid uterus at exam under anesthesia, a >large (3 or 4 cm) fibroid that filled most of the uterine cavity at >hysteroscopy, and several large intramural and subserosal fibroids from >2 to 5 cm distorting the uterus. She had one spot of endo over the >right ureter on the sidewall, and gelatinous goop reminiscent of old PID >hanging from both ovaries, which were otherwise ok (no endo). There was >minimal adhesive disease between the ovaries and the ovarian fossae, >easily broken up with flipping the ovaries, and one tube easily filled >and spilled (the right), and the left was occluded distally with >clubbing. Incidentally, I could see only the left tubal ostium by >hysteroscope. > >So, she needs an open myomectomy, I think, and a goop cleanup at the >same time, as she wishes pregnancy this summer. What should I do, if >anything, with the clubbed tube? > Why did you waste her time and yours with a diagnostic laparoscopy if you didn't plan on fixing anything at the time? If I were your patient I'd be pretty upset to be told that I have fibroids, adhsesions, a clubbed tube and endo and that nothing was done about it. Let's assume you had a surgical complication and the patient died - in essence, she died for nothing. Maybe surgical procedures should be done with a little more consideration for treating the problems that are present.
-- Betty Rommel, MD, PhD
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