Uterine leiomyomas (fibroids) are one of the most common conditions requiring gynecologic care. It affects approximately 20% of women of reproductive age. By the age of 50 years, 70% to 80% of women will be diagnosed with fibroids in their uterus. Uterine fibroids tend to appear at a younger age in black women. They can be small or large, single or multiple and located at different levels within the uterine wall. Abdominal and pelvic pain, uterine bleeding, pelvic pressure and infertility are amongst the most frequent complaints caused by uterine fibroids. Although uterine fibroids are the most frequent indication for hysterectomy in the United States, the desire to preserve childbearing capabilities and fear of losing the uterus require conservative management. Myomectomy (removal of fibroids) with preservation of the uterus is the most common alternative used.
While nonsurgical methods to treat uterine fibroids are available (hormone suppression, uterine artery embolization), surgical myomectomy by laparoscopy, hysteroscopy or abdominal approach are the most frequently used methods to treat uterine symptomatic fibroids. At times, the combination of hormonal suppression (GnRH analogues) to reduce the size of the fibroids is followed by surgical removal of the fibroids. Indications for myomectomy are the same indications supporting the use of hysterectomy for fibroids. They include:
Large asymptomatic fibroid(s) (abdominally palpated)
Excessive uterine bleeding (anemia, fatigue)
Pelvic discomfort (including abdominal pain)
Bladder pressure with urinary frequency
Location of the fibroids within the uterine wall helps to classify the uterine leiomyomas as:
Intramural (within the wall of the uterus)
Submucosal (protruding into the uterine cavity)
Subserosal (protruding into the abdominal cavity)
Pedunculated (small stock protruding into the abdominal cavity)
Complications associated with the surgical treatment of uterine fibroids varies in accordance with the technique used. Complications found when hysterectomy is selected are those associated with the hysterectomy itself in addition to those complications related to injury to adjacent organs caused by the distortion of the normal anatomy that accompanies large size uterine fibroids.
Abdominal myomectomy is associated with short and long term complications. They include;
Cesarean section needed if endometrial cavity was entered during myomectomy
Intraabdominal adhesions (bowel, omentum)
Laparoscopic myomectomy complications are usually associated with the degree of difficulty of the surgical procedure itself. Conversion to open (laparotomy) procedures, intraoperative transfusion and length of surgery are mainly reported. The preoperative use of GnRH analogues to reduce the size of the fibroid and reduce the amount of intraoperative bleeding has been recommended.
Uterine artery embolization was associated with a higher rate of subsequent interventions. While the operative time may be reduced for the initial procedure the rate of postdischarge complications is greater compared with other procedures treating uterine fibroids.
Gynecologists performing myomectomies are responsible for the diagnosis and management of short and long term complications that arise during and following the surgical procedure. If you believe that you or your loved have been misdiagnosed, victims of a traumatic myomectomy or wrongly treated and suspect the postpartum complications may be the result of a medical provider’s error that was diagnosable, avoidable and/or preventable, you may have a valid cause of action. The injury may be the result of a medical provider's mistake in handling your condition and the result of medical negligence. Dr. Borten has over 35 years of experience as an obstetrician and gynecologic surgeon to fully evaluate the merits of your potential case. Allow the Boston area medical malpractice attorneys at Gorovitz & Borten help you assert your rights and get the compensation you deserve.
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