Topics of Interest

Risk of Fibroid “Recurrence” Following Myomectomy

(Excerpted from http://health.groups.yahoo.com/group/uterinefibroids/)

I prefer to have a myomectomy, but I only want to be cut on one time and since I have to have an abdominal myomectomy I thought it would be best to go ahead and do the hysterectomy since there is a very good chance the fibroids will return.

This is an interesting and important topic. I just finished writing a chapter on fibroids for Berek and Novak’s Gynecology textbook – these are a few excerpts with my additional comments in brackets:

  • Individual fibroids, once removed, do not grow back. Fibroids detected after myomectomy, often referred to as “recurrence”, result either from failure of fibroids to be removed at the time of surgery or they are newly developed fibroids. Perhaps this circumstance is best designated “new-appearance” of fibroids.
  • Routine ultrasound follow-up is sensitive, but detects many clinically insignificant fibroids (will not cause symptoms). A study of 40 women who had a normal sonogram 2 weeks following abdominal myomectomy (no fibroids left behind by the surgeon) found that the risk of sonographically detected new fibroids larger than 2 cm was 15% over 3 years.
  • Meaningful information for a woman considering treatment for her fibroids is the approximate risk of developing symptoms that would require yet additional treatment. A study of 125 women followed by symptoms and clinical examination after a first abdominal myomectomy found that a second surgery was required during the follow-up period (average time was 8 years) for 11% of women who had one fibroid removed initially and for 26% of women who had three or more fibroids removed. (reference: Malone L., Myomectomy: recurrence after removal of solitary and multiple myomas. Obstetrics & Gynecology 1969;34:200-203)
  • New appearance of fibroids is not more common following laparoscopic myomectomy when compared with abdominal myomectomy (when performed by skilled laparoscopic surgeons). Eighty-one women randomized to either laparoscopic or abdominal myomectomy were followed with transvaginal sonography every 6 months for at least 40 months. Fibroids larger than 1 cm (so, not clinically significant) were detected in 27% of women following laparoscopic myomectomy compared to 23% in the abdominal myomectomy group, and no woman in either group required any further intervention. (reference: Rossetti A, Sizzi O, Soranna L, et al. Long-term results of laparoscopic myomectomy: recurrence rate in comparison with abdominal myomectomy. Hum Reprod 2001;16:770-774).

Bill Parker, MD

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Disclaimer: The ideas, procedures and suggestions contained on this web site are not intended as a substitute for consulting with your physician. All matters regarding your health require medical supervision.

Fibroid Doctor William H. Parker

Dr. William H. Parker is a board-certified Fellow in the American College of Obstetricians and Gynecologists. Dr. Parker is an internationally recognized expert in fibroid surgery and research. Based in Los Angeles, California, he is considered one of the best fibroid surgeons for abdominal and laparoscopic myomectomy in the United States and abroad. He has been chosen for Best Doctors in America and Top Doctors every year beginning in the late 90's.

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