Hysteroscopic myomectomy: Long-term effects on menstrual pattern and fertility

Paolo Vercellini, Barbara Zàina, Lara Yaylayan, Anna Pisacreta, Olga De Giorgi, Pier Giorgio Crosignani

Research output: Contribution to journalArticle

Abstract

Objective: To determine the effects of hysteroscopic myomectomy on menorrhagia and infertility and the influence of intramural extension on surgical feasibility and long-term outcomes. Methods: We studied 108 women who had first-line hysteroscopic resection of submucous pedunculated (n = 54), sessile (n = 30), or intramural (n = 24) leiomyomas over 7 years at an academic department specializing in endoscopic surgery. Results: The mean (± standard deviation) operating time and distension medium deficit were 18 ± 7 minutes and 204 ± 276 mL in the pedunculated lesion group, 23 ± 9 minutes and 278 ± 269 mL in the sessile lesion group, and 32 ± 8 minutes and 335 ± 272 mL in the intramural lesion group, respectively. More than one procedure was required to complete myoma removal in 14 (26%) of 54, eight (26%) of 30, and 12 (50%) of 24 subjects in the pedunculated, sessile, and intramural lesion groups, respectively. After a mean follow-up of 41 months, myomas recurred in 27 subjects, with a 3-year cumulative rate of 34%. Twenty women had recurrent menorrhagia, with a 3-year cumulative probability of 30%. The 3-year cumulative probability of conception was 49% in women with pedunculated lesions, 36% in those with sessile lesions, and 33% in those with intramural lesions. The study had 80% power to detect five- and three-fold increases in menorrhagia recurrence and conception rates, respectively, in the mainly intramural myoma group compared with the completely or mainly intracavitary myoma group. Conclusion: Hysteroscopic resection of submucous myomas gives satisfactory menorrhagia control and limited recurrence, but the benefit for infertility was less impressive. Myoma intramural extension did not have a substantial influence on any of the long-term outcomes but affected operating time and the number of procedures needed for complete removal. Copyright (C) 1999 The American College of Obstetricians and Gynecologists.

Original languageEnglish
Pages (from-to)341-347
Number of pages7
JournalObstetrics and Gynecology
Volume94
Issue number3
DOIs
Publication statusPublished - Sep 1999

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Uterine Myomectomy
Myoma
Fertility
Menorrhagia
Infertility
Recurrence
Leiomyoma

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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Hysteroscopic myomectomy : Long-term effects on menstrual pattern and fertility. / Vercellini, Paolo; Zàina, Barbara; Yaylayan, Lara; Pisacreta, Anna; De Giorgi, Olga; Crosignani, Pier Giorgio.

In: Obstetrics and Gynecology, Vol. 94, No. 3, 09.1999, p. 341-347.

Research output: Contribution to journalArticle

Vercellini, Paolo ; Zàina, Barbara ; Yaylayan, Lara ; Pisacreta, Anna ; De Giorgi, Olga ; Crosignani, Pier Giorgio. / Hysteroscopic myomectomy : Long-term effects on menstrual pattern and fertility. In: Obstetrics and Gynecology. 1999 ; Vol. 94, No. 3. pp. 341-347.
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abstract = "Objective: To determine the effects of hysteroscopic myomectomy on menorrhagia and infertility and the influence of intramural extension on surgical feasibility and long-term outcomes. Methods: We studied 108 women who had first-line hysteroscopic resection of submucous pedunculated (n = 54), sessile (n = 30), or intramural (n = 24) leiomyomas over 7 years at an academic department specializing in endoscopic surgery. Results: The mean (± standard deviation) operating time and distension medium deficit were 18 ± 7 minutes and 204 ± 276 mL in the pedunculated lesion group, 23 ± 9 minutes and 278 ± 269 mL in the sessile lesion group, and 32 ± 8 minutes and 335 ± 272 mL in the intramural lesion group, respectively. More than one procedure was required to complete myoma removal in 14 (26{\%}) of 54, eight (26{\%}) of 30, and 12 (50{\%}) of 24 subjects in the pedunculated, sessile, and intramural lesion groups, respectively. After a mean follow-up of 41 months, myomas recurred in 27 subjects, with a 3-year cumulative rate of 34{\%}. Twenty women had recurrent menorrhagia, with a 3-year cumulative probability of 30{\%}. The 3-year cumulative probability of conception was 49{\%} in women with pedunculated lesions, 36{\%} in those with sessile lesions, and 33{\%} in those with intramural lesions. The study had 80{\%} power to detect five- and three-fold increases in menorrhagia recurrence and conception rates, respectively, in the mainly intramural myoma group compared with the completely or mainly intracavitary myoma group. Conclusion: Hysteroscopic resection of submucous myomas gives satisfactory menorrhagia control and limited recurrence, but the benefit for infertility was less impressive. Myoma intramural extension did not have a substantial influence on any of the long-term outcomes but affected operating time and the number of procedures needed for complete removal. Copyright (C) 1999 The American College of Obstetricians and Gynecologists.",
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AU - Vercellini, Paolo

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AU - De Giorgi, Olga

AU - Crosignani, Pier Giorgio

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