Unplanned hysterectomy following myomectomy at a tertiary institution: A case series and review of the literature
| Autor: | Karen Ky Kong, W. Catarina Ang, Kelly Mirowska-Allen |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
030219 obstetrics & reproductive medicine Hysterectomy business.industry medicine.medical_treatment General surgery Gold standard Endometriosis Tertiary institution Unplanned hysterectomy medicine.disease Uterine myomectomy 03 medical and health sciences 0302 clinical medicine Blood loss Laparotomy Medicine 030212 general & internal medicine business |
| Zdroj: | Journal of Endometriosis and Pelvic Pain Disorders. 10:151-157 |
| ISSN: | 2284-0273 2284-0265 |
| DOI: | 10.1177/2284026518783664 |
| Popis: | Introduction: Myomectomy is the gold standard uterine-sparing treatment for fibroids. However, the procedure is often complicated by blood loss. In rare cases, haemorrhage may be so severe that a conversion to hysterectomy is warranted. The aim of our study was to investigate the rates of and the clinical reasoning behind unplanned hysterectomies following attempted myomectomies at our institution. Methods: All patients who underwent an open or laparoscopic myomectomy at the Royal Women’s Hospital were identified using a gynaecology unit database, maintained from January 2004 to December 2013. Records for patients whose surgeries were unexpectedly converted to a hysterectomy were examined. A review of the literature was also performed, investigating the rates of unplanned hysterectomies following myomectomies. Results: Of the 1501 myomectomies performed, six resulted in an unplanned hysterectomy; an incidence rate of 0.4%. Fibroids were either intramural or pedunculated with the median number of tumours per patient being 2.5 (interquartile range: 1–6). The largest tumour for each patient varied significantly from 4.0 × 3.2 cm to 29.0 × 25.0 cm. In all cases, despite being strongly advised to have a planned hysterectomy, patients insisted on having a myomectomy. Two patients underwent conversion to hysterectomy intraoperatively while the remainder required a return to theatre. Difficulty achieving intraoperative haemostasis (n = 2), and the development of postoperative bleeding and coagulopathy (n = 4) were reasons cited for proceeding to hysterectomy. Conclusion: The rate of conversion from myomectomy to hysterectomy at our institution was low at 0.4%. In all cases, the reason for conversion was difficulty with haemostasis, despite infrequent use of haemostatic agents, and coagulopathy. |
| Databáze: | OpenAIRE |
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