Myomectomy sneha

MYOMECTOMY DISCUSSED IN BRIEF

1. MYOMECTOMY DR SNEHA RONGE MBBS MS OBGY

2. INDICATIONS In infertility 1. Distorting the uterine cavity Submucous: interfere with fertility and should be removed in infertile patients, regardless of the size or presence of symptoms Intramural: distorting: reduce the chances of conception not distorting: controversial results. Subserosal: No evidence supports removal in asymptomatic, infertile 3. >5-7cm 4. Multiple >3 (3-5 cm) .

3. CONTRAINDICATIONS . 1. No longer desire fertility or uterine preservation. 2. Endometrial cancer or uterine sarcoma. 3. Pregnant. 4. Asymptomatic: No evidence supports prophylactic myomectomy for decreasing the risk of any adverse outcome later in life. 5. Relative contraindications 1. Strong possibility that a functional uterus could not be reconstructed {numerous small F, very large F, adenomyosis} 2. Fibroid located in the region of the uterine vessels or broad ligament

4. PREOPERATIVE ASSESSMENT Small risk of needing to progress to hysterectomy Pre-existing anaemia should be corrected USG , MRI for cervical fibroids Submucus fibroids hysteroscopy

5. UTERINE INCISION Single, anterior, midline vertical incision multiple incisions are minimum. The incision should extend through the serosa, myometrium and into the capsule of the leiomyoma “Stay with in the pseudocapsule and myoma”

6. Every effort should be made to remove all visible and/or palpable myomas If the endometrial cavity is breached, the repair it with fine interrupted extramural sutures using 2/0 vicryl CLOSURE - 1/0 vicryl sutures Interrupted figure of eight sutures

7. BONNEY'S HOOD

8. RISKS AND COMPLICATIONS OF CONVENTIONAL MYOMECTOMY Bleeding Exceptionally rare to have to resort to hysterectomy Infectious morbidity is infrequent Adhesions-meticulous haemostasis Use of minimally reactive absorbable sutures; copious irrigation at the time of myomectomy; paying attention to suturing techniques and, possibly, use of intraperitoneal drains

9. LAP MYOMECTOMY Less than 15 cm(6-10cm) 3 fiborids less than 5 cm Surgeon loses the ability to palpate uterine tissue to detect smaller myomas Incidence of rupture uterus in pregnancy similar with open myomectomy Not adhesion free But incidence of adhesion is less compared to laparotomy Conversion rate to open myomectomy 5%

10. THANKYOU