The surgical treatment of symptomatic uterine fibroids at the university of maiduguri teaching hospital, Maiduguri, Nigeria.

Abstract

Uterine fibroid is commonly seen in our practice and myomectomy and hysterectomy are regular procedures on every gynaecological surgery list in our centre. The only treatment offered for symptomatic uterine fibroids in our environment so far is surgery. Objective: To compare the outcome of abdominal myomectomy and abdominal hysterectomy in the surgical management of uterine leiomyomas. Method: This is a retrospective descriptive study of the outcome of myomectomy and hysterectomy for uterine fibroids at the university of Maiduguri teaching hospital. Hospital records of women with histologically confirmed uterine fibroid who had either abdominal myomectomy or abdominal hysterectomy between January 1, 2003 and December 31, 2007 were reviewed. Results: A total of 221 myomectomies and 110 hysterectomies for uterine fibroids over the study period were reviewed. There was no significant difference in the blood transfusion rates (RR 0.8, 95% CI 0.43- 1.5), postoperative wound infection (RR 2.1 CI 0.6-7.4), wound dehiscence (RR 1.3 95% CI 0.2-6.5), intra operative haemorrhage (RR 0.6 95% CI 0.2-2.0), postoperative pyrexia (RR 1.3 95% CI 0.7- 2.7) and mean duration of hospital stay (myomectomy 8.3 days, hysterectomy 8.2 days P value 0.869) between the hysterectomy and myomectomy groups. Myomectomy was however associated with less mean estimated intraoperative blood loss (myomectomy 364.3ml, hysterectomy
423.6ml; P value 0.004) and decreased risk of intraoperative visceral injury(RR 3.1 95% CI 2.6- 3.6). Conclusion: Myomectomy was associated with a decreased intraoperative blood loss and decreased risk of visceral injury compared with hysterectomy. It can therefore be considered a safe alternative to hysterectomy for symptomatic uterine fibroids. It also has the added advantage of preserving a woman's reproductive function.