Laparoscopic Myomectomy: A 6-Year Experience at Nordica Fertility Center, Lagos, Nigeria

Abstract

Study Objective: To document experience with laparoscopic myomectomy(LM)performed between September 2008 and October 2014. Design(s): Retrospective cohort study. Setting(s): Nordica Fertility Center, Lagos, Nigeria. Patient(s): Thirty one consecutive infertile women(IW) with myomas. Intervention(s): Laparoscopic myomectomy. Measurements and Main Results: In all, 139 histologically confirmed myomas were removed from 31 IW (means(+/-SD) of age and of Body Mass Index were 38.03 [5.3] and 27.38 [4.6] respectively) during laparoscopic myomectomy for symptomatic uterine myoma. Infertility was primary and secondary in 13 (41.9%) and in 18 (58.1%) cases respectively and their mean duration of trying to conceive was 5.69 (3.5) years. Six (19.4%) of these women had undergone previous abdominal uterine surgery including laparoscopic myomectomies (2, 6.4%), open myomectomies (3, 9.7%) and appendicectomy (1, 3.2%). The range of uterine size was 10-24 weeks. Fibroids were observed more in multiple sites (15, 48.4%) than intramural (10, 32.3%) or subserous (4, 12.9%) alone. Two (6.4%) fibroids were exclusively pedunculated. The largest number of fibroid seedlings removed from a patient was 14 and median diameter of the fibroids was 7 cm. Two(6.4%) patients had complications including one hematoma and one excessive haemorrhage warranting conversion to open laparotomy in 1 (3.2%)patient. There was no association between previous abdominal surgeries, body mass index and the rate of complications.The median blood loss was 250mls. Two (6.4%) women required post operation blood transfusion. Median length of hospital stay was 3 days. After hysteroscopy at 8 weeks post LM, 14 (45.2%) of these women proceeded to in-vitro fertilization treatment and 3 (21.4%) became pregnant and delivered live births, one with twins. Conclusion(s): There is relatively low complication rate and short mean duration of hospital stay with LM. Considering the benefits of LM, it should be encouraged even in low resource settings like ours.