Recurrence of uterine myoma after myomectomy: Open myomectomy versus laparoscopic myomectomy 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836951/

Kotani, Yasushi et al. “Recurrence of uterine myoma after myomectomy: Open myomectomy versus laparoscopic myomectomy.” The journal of obstetrics and gynaecology research vol. 44,2 (2018): 298-302. doi:10.1111/jog.13519 

I am presenting an article on a patient I saw with fibroids (History and physical 2). The patient that we saw presented with 15 days of vaginal bleeding with a past medical history of fibroids, that were surgically removed 2 years ago. As per her history, presentation, physical exam and imaging, her current symptoms are consistent with recurrent fibroids. The patient was instructed to follow up with her OB/GYN for further workup and evaluation for a repeat surgery.  

This article looks at recurrent cases of repeat fibroids post either open myomectomy vs laparoscopic myomectomy. Previously open myomectomy was the preferred procedure, however recently laparoscopic myomectomy has become more common.  In this study 474 patients underwent a laparoscopic myomectomy and 279 patients underwent an open myomectomy; they were then followed post-operatively for 6 months to 8 years to assess for recurrent fibroids bigger then 1cm. The results were then calculated on a Cox hazard score. It was found that the procedures that were done  laparoscopically yielded a higher recurrence rate then open myomectomies. This is a due to manual fibroid removal in an open procedures which allows for a better removal of smaller myomas then that which is removed in laparoscopic surgery. Since there are fewer residual fibroid masses left\ 

However since there is less risk of any post operative injuries and infections in laparoscopic procedures, it is preferred more. The use of open myomectomy is often needed for extremely large fibroids, or a large number of fibroids. It was found that even though open surgery produced a lower fibroid recurrence rate, it was still often only used when needing to treat complicated and challenging cases.  

In summary, laparoscopic procedures are  preferred for the prevention and reduced risk of psot operative adhesions and infections, however open myomectomies are preferred to reduce rates of fibroid recurrence and need for repeat surgeries.  

The patient that we interviewed did not remember what type of myomectomy procedure she had done, and was also too uncomfortable to answer follow up questions. However, after reading this article, I am interested to know which type of procedure she had done due to her recurrence 2 years after her surgery.