The Effect of Uterine Artery Occlusion with Tourniquet on Ovarian Reserve during Open Myomectomy at a University Teaching Hospital in Southern Nigeria

Background: The most common surgical treatment for symptomatic uterine fibroids, particularly in women with fertility concerns, is open myomectomy. Given the high vascularity of the uterus, haemorrhage during the procedure is a serious risk that is often mitigated with a uterine tourniquet. Aim and Objectives: To evaluate the effect of uterine artery occlusion with a tourniquet during open myomectomy on ovarian reserve using serial anti-Mullerian hormone (AMH) measurements. Materials and Methods: This was a prospective longitudinal study with a quasi-experimental design and a convenient sampling technique. The study enrolled 47 women who had abdominal myomectomy between September 1, 2021, and March 31, 2022, at the University of Port Harcourt Teaching Hospital. Blood samples were collected before anaesthesia was administered in theatre, on day two, and three months after open abdominal myomectomy for anti-Mullerian hormone assay. The data was collected using a semi-structured proforma, entered into an Excel spreadsheet, and analyzed using SPSS version 25.0 with a 95% confidence interval. Statistical significance level was set at 0.05. Results: The pre-surgery AMH mean value was 1.67 ± 1.44 ng/ml, while the values after using a uterine tourniquet at myomectomy on the second day and three months later were 1.22 ± 1.24 ng/ml and 1.59 ± 1.43 ng/ml, respectively. There was no statistically significant change in AMH levels, and there was no statistically significant relationship between blood loss and tourniquet time and AMH after open abdominal myomectomy. Conclusion: The use of a uterine tourniquet and blood loss during open myomectomy has no effect on ovarian reserve.

Faster Healing Process by Sparing Intramural Myoma’s Pseudocapsule during Laparoscopic Myomectomy Compared with Removing It during Open Myomectomy

Uterine fibroids are the most common benign tumours in the reproductive system. They are proliferations of smooth muscle cells of the myometrium containing a large quantity of extracellular matrix and they are surrounded by a pseudo capsule of compressed areolar tissue and smooth muscle cells. They can cause various symptoms such as menorrhage, pain and infertility and therefore they can be a traumatic experience for several women. The treatment of choice is myomectomy. In the past, myomectomy was performed by relatively atraumatic techniques, which involved stretching the myoma from its pseudocapsule to extract the fibroid directly from the surrounding fibromuscular tissue, breaking up the fibrous bridge. Modern laparoscopic intracapsular myomectomy (LIM), however, leaves the fibrovascular network surrounding the myoma (namely the “fibroid neurovascular bundle”) intact which reduces the bleeding and/or uterine musculature trauma, and spares the neuropeptide fibers of the pseudocapsule. In this observational study, we compare the two techniques-laparoscopic intracapsular myomectomy (LIM) and conventional abdominal myomectomy (CAM) regarding the longterm uterine healing and a significantly faster healing process of the uterine incision was achieved by LIM compared to CAM.

Laparoscopic myomectomy versus open myomectomy in uterine fibroid treatment: A meta-analysis

Objective:Uterine fibroids are the most commonly occurring benign solid tumors in women,and laparoscopic or open myomectomy constitutes the primary option for treatment.However,both methods are under debate currently in terms of efficacy and safety.In this meta-analysis we assessed the efficacy and safety of the two procedures.Methods:We conducted a comprehensive literature search of PubMed,ScienceDirect,and the Cochrane Library in December 2020.The search terms included“open myomectomy”,“myomectomies”,“laparoscopic”,and“uterine fibroids”.We then selected the randomized control trials published from 1996 to 2019 and compared laparoscopic and open myomectomies.Results:We included 10 studies of 449 patients who underwent laparoscopic myomectomy and 449 patients who underwent open myomectomy.The data revealed that laparoscopic myomectomy was associated with reduced blood loss(MD=-34.43;95%CI,-34.92 to-33.94;p<0.001),an attenuated decline in hemoglobin(MD=-1.04;95%CI,-1.14 to -0.93;p<0.001),less post-operative pain at 24 h(MD=-0.51;95%CI,-0.83 to -0.19;p=0.002),and fewer overall complications(OR=0.42;95%CI,0.24 to 0.71;p=0.001)relative to open myomectomy;but the former possessed a longer operative time(MD=12.96;95%CI,9.94 to 15.97;p<0.001).There were no significant differences in pregnancy rate(OR=1.39;95%CI,0.72 to 2.68;p=0.33)or recurrence rate of postoperative uterine fibroids(OR=1.15;95%CI,0.60 to 2.18;p=0.67)between the two groups.Conclusion:Laparoscopic myomectomy displayed superior results compared to open myomectomy,although the former involved a longer operating time.

Giant exophytic cystic adenomyosis with a levonorgestrel containing intrauterine device out of the uterine cavity after uterine myomectomy: A case report

A cystic lesion arising from the myometrium of the uterus,termed as cystic adenomyosis,has chocolate-like,thick viscous contents and contains various amounts of endometrial stroma below the glandular epithelium.It is an extremely rare type of adenomyosis.CASE SUMMARY Herein,we report an unusual case of a giant cystic mass in the pelvic cavity after uterine myomectomy.The patient complained of abnormal uterine bleeding and severe dysmenorrhea.After a levonorgestrel-containing intrauterine device(LNG-IUD)was inserted,her symptoms were greatly alleviated.However,the LNG-IUD was detected in the cystic cavity during the follow-up.For fear of the intrauterine device migrating into and damaging the surrounding viscera,surgical treatment was proposed.Therefore,laparoscopic resection of the lesion and removal of the LNG-IUD were performed and cystic adenomyosis with an LNG-IUD out of the uterine cavity was diagnosed.CONCLUSION We believe that myomectomy breaking through the endometrial cavity may have been a predisposing factor for the development of cystic adenomyosis in this case.

Benefits and Limitations of Laparoscopic Myomectomy

Uterine fibroids (also called leiomyoma or myoma) are the most common benign tumor among women of childbearing age. These are often discovered during bimanual examinations and/or ultrasound examinations. Laparoscopic myomectomy offers several benefits to patients such as less blood loss during operation, quick postoperative recovery and shorter hospital stay in comparison to open myomectomy. It has been widely used over the past decades as possible alternative to the traditional laparotomy. In spite of several benefits laparoscopic myomectomy has certain drawbacks such as prolonged time of anesthesia, time consuming procedure, comparatively expensive and weak strength of the uterine scar. Furthermore laparoscopic myomectomy is technically challenging procedure so it requires high degree of training and skill to perform it. Due to its several advantages, it should be taken into consideration for the removal of uterine fibroids.

Parasitic leiomyoma in the trocar site after laparoscopic myomectomy:A case report

BACKGROUND Laparoscopic myomectomy is increasingly used for resecting gynecological tumors.Leiomyomas require morcellation for retrieval from the peritoneal cavity.However,morcellated fragments may implant on the peritoneal cavity during retrieval.These fragments may receive a new blood supply from an adjacent structure and develop into parasitic leiomyomas.Parasitic leiomyomas can occur spontaneously or iatrogenically;however,trocar-site implantation is an iatrogenic complication of laparoscopic uterine surgery.We describe a parasitic leiomyoma in the trocar-site after laparoscopic myomectomy with power morcellation.CASE SUMMARY A 50-year-old woman presented with a palpable abdominal mass without significant medical history.The patient had no related symptoms,such as abdominal pain.Computed tomography findings revealed a well-defined contrast-enhancing mass measuring 2.2 cm,and located on the trocar site of the left abdominal wall.She had undergone laparoscopic removal of uterine fibroids with power morcellation six years ago.The differential diagnosis included endometriosis and neurogenic tumors,such as neurofibroma.The radiologic diagnosis was a desmoid tumor,and surgical excision of the mass on the abdominal wall was successfully performed.The patient recovered from the surgery without complications.Histopathological examination revealed that the specimen resected from the trocar site was a uterine leiomyoma.CONCLUSION Clinicians should consider the risks and benefits of laparoscopic vs laparotomic myomectomy for gynecological tumors.Considerable caution must be exercised for morcellation to avoid excessive tissue fragmentation.

Laparoscopic versus Abdominal Myomectomy: Surgical and Post-Operative Outcomes in CHRACERH-Yaounde

Introduction: Fibroid benign tumour of the uterus can be operated either by laparotomy or laparoscopy. Laparoscopy is not well vulgarised in our settings. Objective: The main objective was to compare the surgical and post-operative outcomes of laparoscopic versus abdominal myomectomy. Methods: We performed a comparative analytical cross sectional study from 1st January 2016 to 31st March 2018 consisted of two groups: group 1 of women who underwent laparoscopic myomectomy (LM) and group 2 of women who underwent abdominal myomectomy (AM). The data collected was entered in Epi Info 7.2 version and exported to IBM SPSS Statistics version 22 for analysis. We used alpha error margin of 5% and confidence interval of 95%. Results: We enrolled 50 cases of myomectomy consisted of 33 (66.0%) files for AM and 17 (34.0%) files for LM. The clinical presentation of fibroid was similar in both groups. The main operation time (H) was (1.27 ± 0.13) for laparoscopy which is much less than (2.05 ± 0.07) for laparotomy group (p = 0.006). In AM group we had 04 post-operatory complications against zero complications in LM group but the difference was not statistically significant (p = 0.387). In the second look laparoscopy, the types of adhesions were not statistically significant (p = 0.471). Conclusion: Laparoscopic offers advantages compared to abdominal myomectomy.

A comparative analysis of spontaneous fertility after myomectomy by laparotomy associated or not with a“second look”laparoscopy

Objective:The importance of a“second look”laparoscopy for adhesion formation after myomectomy by laparotomy in improving fertility is not clearly defined in our context.The aim of this study was to compare spontaneous fertility after myomectomy by laparotomy between women who underwent a“second look”laparoscopy and those who did not.Methods:We conducted an analytical cross-sectional study with retrospective data collection from January 1,2008 to December 31,2015,comparing spontaneous fertility between patients who underwent“second-look”laparoscopy after myomectomy by laparotomy to those who did not.Firstly,data was collected from the records of patients included in the study.Secondly,through phone calls,informed consent for each participant was obtained after which inquiries were made regarding their fertility status.Results:After a period of 24 months,23 patients(47.9%)with“second look”laparoscopy conceived,compared to 37 patients(35.2%)without“second look”laparoscopy(p=0.136);and 24 patients(50.0%)with“second look”had term pregnancies compared to 39 patients(37.1%)without“second look”laparoscopy(p=0.134).Conclusion:Spontaneous fertility rates seemed to be improved after a“second look”laparoscopy,however,there was no statistically significant difference between spontaneous fertility rates obtained after myomectomy by laparotomy,irrespective of the fact that the patient had undergone a“second look”laparoscopy or not at Yaounde Gyneco-Obstetric and Pediatric Hospital.

Enterovesical Fistula Complicating Myomectomy: A Case Report

Background: Enterovesical fistula is an abnormal communication between the bladder and the gastrointestinal tract. It is an uncommon type of genital fistula, occasionally complicating pelvic surgeries. However, it is the most common type of fistula associated with diverticular disease of the colon. Other causes include cancer, trauma and iatrogenic injuries. Pneumaturia and fecaluria usually implies enterovesical fistula. Enterovesical fistula complicating myomectomy is an uncommon finding. Our aim is to report a case of enterovesical fistula following myomectomy. Case presentation: She is a 33-year-old nullipara who presented at the National Obstetric Fistula Centre, Abakaliki, Ebonyi State, South-Eastern Nigeria with a history of fecaluria, pneumaturia and haematochezia which started after myomectomy. Feculent fluid was obtained on urethral catheterization. Cystography was suggestive of enterovesical fistula. Conclusion: Enterovesical fistula is a possible complication of myomectomy. A high index of suspicion for this rare but potentially devastating condition is important for early diagnosis and appropriate management.

Pseudoaneurysm after abdominal myomectomy: A rare but catastrophic complication

Background: Uterine artery pseudoaneurysm is a rare diagnosis made postoperatively after pelvic surgery. The exact etiology is unknown however it is speculated to occur when an artery is lacerated and the perivascular tissue maintains persistent blood flow with the parent vessel. It can present with severe hemorrhage two to four weeks after an uncomplicated post operative course. Case: A 45 year old presented with vaginal hemorrhage and hypotension two weeks after abdominal myomectomy. Transvaginal ultrasound with doppler diagnosed pseudoaneurysm of the uterine artery. The patient was successfully treated with endovascular embolization utilizing micro coils. Conclusion: Transvaginal ultrasound is a useful technique in diagnosing pseudoaneurysms. Endovascular embolization is a minimally invasive, safe and effective way to treat this rare complication in institutions that have access to interventional radiology procedures.

Effect of laparoscopic myomectomy on inflammatory reaction, immune function, stress hormones and ovarian function

Objective: To investigate the effect of laparoscopic myomectomy on inflammatory reaction, immune function, stress hormones and ovarian function. Methods: Selected a total of 82 patients with hysteromyoma accorded with the screening criteria as the objects of study, according to the random data table, the patients were divided into the control group (n=41) and the observation group (n=41);The patients in the control group received traditional laparotomy myomectomy, and the observation group patients received laparoscopic myomectomy. The inflammatory reaction, immune function, stress hormone and ovarian function levels were compared between the two groups before and after treatment (before operation and after 1 d of operation). Results: After comparison, before treatment the difference of TNF-α, CRP, CD3+, CD4+, CD8+, CD4+/CD8+, COR, NE, LH, FSH and E2 levels between the groups was not statistically significant;After treatment, the TNF-α, CRP, CD8+, COR, NE, LH and FSH levels of two groups were significantly increased, and the levels after treatment in the control group were significantly higher than the observation group, the difference was statistically significant;The levels of CD3+, CD4+, CD4+/CD8+ and E2 in the observation group were significantly higher than those in the control group, the difference was statistically significant. Conclusion: Laparoscopic myomectomy can effectively reduce the inflammatory reaction and stress reaction, and have a less influence on the immune function and ovarian function, which is more conducive to postoperative rehabilitation.

Comparison of the degree of inflammatory stress response of laparoscopic myomectomy and abdominal surgery

Objective: To study the degree of inflammatory stress response of laparoscopic myomectomy and abdominal surgery. Methods: Patients who underwent myomectomy in Maternal and Child Health Hospital of Dayi County between June 2014 and October 2017 were retrospectively analyzed, and according to different operation methods, they were divided into the laparoscopy group and the control group who underwent laparoscopic surgery and open surgery respectively. The contents of inflammatory factors and stress mediators in serum as well as the expression of inflammatory molecules and stress molecules in peripheral blood were measured before surgery and 1 d after surgery. Results: Compared with those of same group before surgery, serum TNF-α, sICAM1, sVCAM1, sTREM1, GH, Cor, C-P, FT4 and CRP levels as well as peripheral blood JAK2, STAT3, Notch2, Hes1, Nrf2, HO-1, MPO and FOXP3 expression intensity of both groups of patients were significantly higher after surgery, and serum TNF-α, sICAM1, sVCAM1, sTREM1, GH, Cor, C-P, FT4 and CRP levels as well as peripheral blood JAK2, STAT3, Notch2, Hes1, Nrf2, HO-1, MPO and FOXP3 expression intensity of laparoscopy group of patients after surgery were lower than those of control group. Conclusion: Compared with abdominal surgery, laparoscopic myomectomy can reduce the degree of postoperative inflammatory stress response.

Comparison of the degree of inflammatory stress response of laparoscopic myomectomy and abdominal surgery

Objective:To study the degree of inflammatory stress response of laparoscopic myomectomy and abdominal surgery.Methods: Patients who underwent myomectomy in Maternal and Child Health Hospital of Dayi County between June 2014 and October 2017 were retrospectively analyzed, and according to different operation methods, they were divided into the laparoscopy group and the control group who underwent laparoscopic surgery and open surgery respectively. The contents of inflammatory factors and stress mediators in serum as well as the expression of inflammatory molecules and stress molecules in peripheral blood were measured before surgery and 1 d after surgery.Results: Compared with those of same group before surgery, serum TNF-α, sICAM1, sVCAM1, sTREM1, GH, Cor, C-P, FT4 and CRP levels as well as peripheral blood JAK2, STAT3, Notch2, Hes1, Nrf2, HO-1, MPO and FOXP3 expression intensity of both groups of patients were significantly higher after surgery, and serum TNF-α, sICAM1, sVCAM1, sTREM1, GH, Cor, C-P, FT4 and CRP levels as well as peripheral blood JAK2, STAT3, Notch2, Hes1, Nrf2, HO-1, MPO and FOXP3 expression intensity of laparoscopy group of patients after surgery were lower than those of control group. Conclusion: Compared with abdominal surgery, laparoscopic myomectomy can reduce the degree of postoperative inflammatory stress response.

Myometrial smooth muscle cells spillage during open myomectomy:Is it True or a myth?

Background:Uncontained morcellation of myoma during laparoscopic surgery has been discouraged because of unknown malignancy.Even the safety of contained morcellation has been questioned because muscle cells have been detected in washings obtained during laparoscopic procedures.The possibility of myoma cell dissemination has been observed in open abdominal surgery,even after hysterectomy.Thus myomectomy would be unsafe from an oncological point of view,regardless of surgical approach.Methods:This is an observational cohort study involving 30 patients who underwent open abdominal myomectomy.Peritoneal abdominal washings were obtained two times during the open abdominal myomectomy:before uterus incision and after the myomectomy itself.Cytological,cell block,and immunohistochemical evaluations were performed.Results:All washings obtained immediately after abdominal peritoneal cavity opening were negative for fibroid cells.Both the first and second washings were free of myoma cells.Cytologic evaluation did not reveal any smooth muscle cells.The results of desmin and smooth muscle actin staining,performed on the pre-and postmyomectomy samples,were negative.Conclusion:Our results demonstrated,for the first time to our knowledge,that there is no dissemination of myoma cells during conservative abdominal surgery.It could represent an additional oncological safety.Further data are needed.

Uterine artery embolization combined with percutaneous microwave ablation for the treatment of prolapsed uterine submucosal leiomyoma:A case report

BACKGROUND Vaginal myomectomy is the most common form of radical treatment for prolapsed submucosal leiomyoma and is typically performed under general anesthesia.However,an alternative treatment approach is needed for patients who cannot tolerate general anesthesia.We describe a case with such a patient who was successfully treated via a minimally invasive method under local anesthesia.CASE SUMMARY A 46-year-old female suffered from abnormal uterine bleeding,severe anemia,and a reduced quality of life attributed to a massive prolapsed submucosal leiomyoma.She could not tolerate general anesthesia due to a congenital thoracic malformation and cardiopulmonary insufficiency.A new individualized combined treatment,consisting uterine artery embolization(UAE),percutaneous microwave ablation(PMWA)of the pedicle and the endometrium,and transvaginal removal of the leiomyoma by twisting,was performed.The lesion was completely removed successfully under local anesthesia without any major complications.The postoperative follow-up showed complete symptom relief and a significant improvement in the quality of life.CONCLUSION UAE combined with PMWA can be performed under local anesthesia and is a promising alternative treatment for patients who cannot tolerate general anesthesia.

Surgical Management of Uterine Fibroids: About 175 Cases

Background: Uterine fibroids are a common condition in Senegal and often symptomatic. Our study aims to determine the epidemiological profile, to clarify the diagnostic aspects and to evaluate the surgical management of patients with uterine fibroids. Patients and Method: We carried out a retrospective and descriptive study carried out over a period of 30 months, from August 1, 2017 to January 31, 2020, concerning all patients who underwent surgery for the treatment of uterine myomatosis in the department of Gynecology Obstetrics of the Hospital Principal of Dakar. The data was collected from the patients’ medical records and analyzed using Excel version 2016 and R version 4 software. Results: We collected 175 surgical interventions for uterine fibroids, representing 44.7% of gynecological interventions. Most of the patients were between 30 and 39 years old, with an average age of 39 years. The nulliparous were the majority with 64.6%. The clinical symptomatology was represented by genital bleeding (32.6%), pelvic pain (18.85%) and infertility (12.6%). The diagnosis was confirmed by pelvic ultrasound in all patients with variable myoma topography. A myomectomy was performed in 82.3% of cases and a total hysterectomy in 17.7%. The postoperative course was simple in 94.2% of cases, and the results of treatment revealed a disappearance of symptoms in 94.3% of cases. Conclusion: Surgery occupies a prominent place in the management of uterine fibroids.

腹腔镜下腹壁小切口子宫肌瘤剥除术的临床效果

目的 探讨腹腔镜下腹壁小切口子宫肌瘤剥除术在临床的治疗效果及应用.方法 采用前瞻性队列研究方法,分别连续纳入2009年1月至2012年1月到我院妇产科患子宫肌瘤的育龄期妇女接受腹腔镜下腹壁小切口子宫肌瘤剥除术60例、接受腹腔镜肌瘤剥除术60例和接受阴式肌瘤剥除术30例.分为小切口组、腹腔镜组、阴式组,随访3年.比较三组手术情况、术后检测、术后实验室检查结果、住院情况及3年后的随访结果.结果 在校正了肿瘤情况后,与小切口组对比,在腹腔镜组中,患者失血量显著增长,手术时间显著增长,费用显著增多,但住院天数显著减少（P〈0.05）,阴式组中,患者手术时间显著增长,肛门排气时间显著增长,但住院天数显著减短（P〈0.05）.在校正了术前数值后,腹腔镜组及阴式组患者子宫动脉阻力指数RI显著低于小切口组,腹腔镜组患者术后LH显著高于小切口组（P〈0.05）,术后两组其他激素值未见显著差异（P〉0.05）.术后随访结果三组未见显著差异（P〉0.05）,但提示腹腔镜复发率和术后妊娠子宫破裂率可能较高.结论 三种手术方式各有利弊,应根据具体情况选择术式,腹腔镜下腹壁小切口子宫肌瘤剥除术与其他两种相比,适用广泛,具有较好的疗效和预后,能够减低手术难度和医疗费用,值得临床广泛应用.

Tranexamic acid for the management of uterine fibroid tumors:A systematic review of the current evidence

AIM: To conduct a detailed systematic review of the current evidence on the administration and efficacy of tranexamic acid in patients with menorrhagia due to uterine fibroids. METHODS: We conducted an electronic search on the following databases Pub Med and Medline(1950-2013);(1980-2013); Cochrane library(1993-2013). RESULTS: A total of 36 articles were retrieved after the initial electronic search. Careful assessment of the retrieved studies led to the final selection of 5 articles for inclusion in the review. CONCLUSION: Tranexamic acid may reduce blood loss perioperatively in myomectomies. It may reduce the menorrhagia in patients with fibroids, however a stratification of fibroids by size and location is required to define the responses. It is safe in general, with mild adverse effects observed in some cases. More studies with a double-blind randomized design and larger numbers of participants are necessary to reach more precise and safe conclusions.

Diffuse uterine leiomyomatosis: A case report and review of literature

BACKGROUND Diffuse uterine leiomyomatosis(DUL)is a benign uterine smooth muscle neoplasm with unknown etiology.Since DUL is rarely reported,knowledge regarding it is limited.The rate of early diagnosis is low,and DUL is often misdiagnosed as common multiple uterine leiomyomas before surgery.CASE SUMMARY A 27-year-old patient with no sexual activity presented to the Emergency Department of our hospital complaining of heavy vaginal bleeding.She had a history of uterine fibroids and menorrhagia.Pelvic examination showed a regularly enlarged uterus,similar in size to that associated with a 4-mo pregnancy.Pelvic magnetic resonance imaging(MRI)revealed numerous multiple uterine fibroids,and a transabdominal myomectomy(TM)was performed.Intraoperative exploration revealed that the myometrium was full of myoma nodules of variable sizes.Over 50 leiomyomas were removed.The pathology report confirmed leiomyoma.The patient was discharged and received a gonadotropin-releasing hormone analog(3.75 mg)for 6 mo.Ten months after surgery,the patient presented to the hospital again for abnormal uterine bleeding.MRI showed an irregular mass with a diameter of 5.2 cm without sharp demarcation in the uterine cavity.Submucosal leiomyoma was considered first,and the patient underwent a hysteroscopic myomectomy plus hymen repair.Intraoperative exploration showed that there were several leiomyomatosis masses in the cavity.Postoperative pathological exam-ination confirmed submucosal leiomyoma and necrotic and generative tissue.Although the menstrual cycle was still irregular,the patient did not have symptoms of menorrhagia for a period of 28 mo after the second surgery.CONCLUSION Individuals with DUL are easily misdiagnosed due to the lack of specific manifestations of this disease.MRI is helpful for early identification and preoperative evaluation.There is currently no unified method of diagnosis.For women who want to preserve fertility,conservative surgery should be made an option.When TM is chosen,a modified new myomectomy should be considered to avoid the drawbacks of traditional TM.

Surgical Intervention on Uterine Fibromyoma in a Country with Limited Resources: Case of the Gynaecology-Obstetrics Department of the Communal Medical Centre of Ratoma Conakry-Guinea

In developing countries, treatment of uterine fibromyoma is confronted with numerous problems, namely: financial inaccessibility to the proposed treatments, fear of surgery and the weakness of the technical platform.?Objectives: The objectives of the study were to calculate the frequency of uterine fibromyomas, describe the socio-demographic characteristics of patients, identify the main clinical data and to describe the modalities of surgical management.?Patients and Method:?It was a mixed descriptive study, cumulative over a period of 5 years (60 months) with data collection in two phases: a 4-year retrospective study from January 1, 2015 to December 31, 2018 and a 1-year prospective study from January 1, 2019 to December 31, 2019.?Results: We collected 135 cases of uterine fibromyomas operated on out of a total of 260 cases of gynaecological pathologies, i.e.?a frequency of 51.92%.?Nulliparous women were the most concerned (45.18%), and women who attended school (60%) and those who did not attend school (40%). Women at home and housewives accounted for 42.20% and 54.07% respectively. Clinically, the circumstances of discovery were dominated by menometrorrhagia and menorrhagia respectively 77.77% and 68.14%. The large uterus was the most frequent physical sign found in 96.29% of cases. Uterine fibromyomas were recorded in 86.6% of cases in women with genital activity. The operative indications were dominated by the large polymyomatous uterus (64.44%), followed by hemorrhagic fibroma (18.52%).?The surgical treatment was conservative in 92.60%. The total hysterectomy performed in 7.40.?Lethality was 1.4%.?Conclusion: The surgical management of fibroids contrasts conservative treatment (myomectomy) with radical treatment (hysterectomy) with multiple possible approaches (hysteroscopy, vaginal surgery, laparoscopy or laparotomy). In our context, only laparotomy was possible due to lack of equipment. Laparoscopy and hysteroscopy equipment is necessary for less invasive surgery.