[Myomectomy: laparoscopy or laparotomy].

OBJECTIVE

The purpose of this study of 109 myomectomies is to evaluate the feasibility, limits and results in term of fertility of the laparoscopic myomectomy.

MATERIAL AND METHODS

Retrospective study from January 1990 to December 1993, including 109 patients having had a myomectomy, 39 by laparotomy (35,7%) and 70 by laparoscopy.

RESULTS

The average number of myomas extracted by laparoscopy and by laparotomy were 1.5 and 6.7 respectively. The diameter of the major myoma was 7 cm in the laparotomic group versus 6.2 cm in the laparoscopic group. Among 70 myomectomies approached by laparoscopy, 29 (41,4%) have necessitated a laparoconversion. The reason of this conversion was mainly the size of the myoma (superior 5 cm) in 21 cases, the number of myomas (superior 5) in 6 cases, the interstitiel location of the myoma in 1 case and a per-operative hemorrhage in 1 case. Among 109 patients having had a myomectomy, 60 (55%) desired a pregnancy including 22 patients having laparoscopy myomectomy. Among these 22 patients, 8 have been pregnant (36.4%) allowing 9 pregnancies (4 deliveries, 4 missed abortions and 1 intrauterin fetal death).

CONCLUSION

Our results confirm that the laparoscopic myomectomy would have to be reserved to patients presenting to the most 4 myomas with a diameter < or = 7 cm. Results in term of fertility of the laparoscopic myomectomy are similar to these of patients having a laparoconversion.