Re: GYN: fibroids/future fertility
From: Myer S. Bornstein (mborn@massmed.org)
Fri Feb 27 16:59:30 1998
With these findings, I would first pretreat the patient with a GnRH agonist
for at least two months. In the next month plan on a hysteroscopic
resection of the submucus fibroid, followed at the same sitting by a
laparoscopic or open Myomectomy and release of the fimbria.
--
Myer S. Bornstein, M.D. FACOG
Director Department of Obstetrics and Gynecology
Morton Hospital and Medical Center
Taunton, MA 02780
Mass State Representative obgyn.net
mborn@massmed.org
-----Original Message-----
From: John Robertson M.D. <john.robertson@obgyn.net>
To: Multiple recipients of list <ob-gyn-l@talk.obgyn.net>
Date: Friday, February 27, 1998 4:59 PM
Subject: Re: GYN: fibroids/future fertility
>At Fri, 27 Feb 1998, Betty Rommel, MD, PhD wrote:
>>
>>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
>>
>Betty, I don't know how it works for Garry, but for me a diagnostic
>laparoscopic procedure, and a therapeutic open procedure are 2
>completely different things. For starters the consent for surgery is
>different, and converting a procedure into an open case for therapeutic
>(as apposed to life saving) reasons may well not be part of the consent.
>A lot of these patients would be very upset to wake up and find they are
>going to be in hospital for 5 days and off work for 6 weeks as apposed
>to home in the afternoon and back to work in a few days. A diagnostic
>procedure is just that, done for diagnosis. It is unlikely that Garry
>knew exactly what he was going to see before he went in, and as his post
>suggests, the findings need to be considered prior to planning
>definitive surgery. Maybe the patient will say "thanks but no thanks"
>and walk away. Maybe she doesn't want the increased risk of bleeding
>that the surgery (as proposed by Garry) would entail (increased above
>the diagnonstic procedure. I'm sure Gary had a talk with this patient
>prior to the procedure, and the options for management were discussed.
>
>--
>J.G.M.Robertson MD, 109-9181 Main St. Chilliwack, B.C. V2P 4M9
>(604) 793-9988 e-mail john.robertson@obgyn.net
>Who is wise and understanding among you? Let him show it by his good life,
>by deeds done in the humility that comes from wisdom. James 3 vs 13, NIV
>
