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Hysteroscopic Myomectomy: Long-Term Effects on Menstrual Pattern and Fertility

From the Clinica Ostetrica e Ginecologica "Luigi Mangiagalli," University of Milan, Milan, Italy.

Address reprint requests to: Paolo Vercellini, MD Clinica Ostetrica e Ginecologica "Luigi Mangiagalli" Università di Milano, Via Commenda 12 20122 Milan Italy E-mail: pgcros{at}imiucca.unimi.it

Objective: To determine the effects of hysteroscopic myomectomy on menorrhagia and infertility and the influence of intramural extension on surgical feasibility and long-term outcomes.

Methods: We studied 108 women who had first-line hysteroscopic resection of submucous pedunculated (n = 54), sessile (n = 30), or intramural (n = 24) leiomyomas over 7 years at an academic department specializing in endoscopic surgery.

Results: The mean (± standard deviation) operating time and distension medium deficit were 18 ± 7 minutes and 204 ± 276 mL in the pedunculated lesion group, 23 ± 9 minutes and 278 ± 269 mL in the sessile lesion group, and 32 ± 8 minutes and 335 ± 272 mL in the intramural lesion group, respectively. More than one procedure was required to complete myoma removal in 14 (26%) of 54, eight (26%) of 30, and 12 (50%) of 24 subjects in the pedunculated, sessile, and intramural lesion groups, respectively. After a mean follow-up of 41 months, myomas recurred in 27 subjects, with a 3-year cumulative rate of 34%. Twenty women had recurrent menorrhagia, with a 3-year cumulative probability of 30%. The 3-year cumulative probability of conception was 49% in women with pedunculated lesions, 36% in those with sessile lesions, and 33% in those with intramural lesions. The study had 80% power to detect five- and three-fold increases in menorrhagia recurrence and conception rates, respectively, in the mainly intramural myoma group compared with the completely or mainly intracavitary myoma group.

Conclusion: Hysteroscopic resection of submucous myomas gives satisfactory menorrhagia control and limited recurrence, but the benefit for infertility was less impressive. Myoma intramural extension did not have a substantial influence on any of the long-term outcomes but affected operating time and the number of procedures needed for complete removal.

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