Uterine Fibroids

Fibroids are the most common uterine neoplasm affecting approximately 20% to 25% of women of reproductive age. The severity of symptoms associated with uterine leiomyomas depends on the number of tumors, their size, and location. They may cause abdominal pressure, urinary frequency, constipation or alter blood flow to the uterus and endometrium.

The choices for a woman with fibroids revolves around:

  1. No treatment
  2. Myomectomy
  3. Hysterectomy

In most cases, it is the patient who makes the decision between the above choices.

To this equation, we add the choice of laparoscopic treatment versus a large incision for both 2. and 3.

Almost all fibroids can be treated using a laparoscopic approach despite large size. Few surgeons have mastered these techniques.

Fibroids less than 5 cm can usually be left alone unless accompanied by heavy bleeding leading to anemia.

Multiple large fibroids are best treated by laparotomy myomectomy (incision) or laparoscopic hysterectomy.

Remember that large incisions cause adhesions in over 90% of cases and that 50% of these women will have an adhesion related hospital admission over the ensuing next 10 years.

Lower, A. M., Hawthorn, R. J., Ellis, H., O'Brien, F., Buchan, S. and Crowe, A. M. The impact of adhesions on hospital readmissions over ten years after 8849 open gynaecological operations: an assessment from the Surgical and Clinical Adhesions Research Study. Bjog 107: 855-862, 2000