Abdominal Myomectomy: Risk Assessment and Management

Introduction to Risks and Benefits

Abdominal myomectomy is considered a moderate-risk surgical procedure with significant potential for complications, particularly intraoperative hemorrhage requiring blood transfusion, but it is not classified as high-risk surgery when performed by experienced surgeons 1, 2, 3

Open abdominal myomectomy is associated with greater risk of adhesion formation 1, 3
Laparoscopic myomectomy offers faster return to usual activities 1
Laparoscopic myomectomy has lower rates of wound infection compared to abdominal approach 3
Hysteroscopic myomectomy has shorter hospitalization 2
Hysteroscopic myomectomy has faster recovery than abdominal approaches 1
Hysteroscopic myomectomy results in equivalent improvement in symptom scores at 2-3 months 2, 3

Application of tourniquets on vascular pedicles can minimize blood loss during myomectomy 4
Myometrial injection of vasospastic agents such as vasopressin can reduce blood loss 4
Preoperative correction of anemia can reduce risk 4
Storage of autologous blood can reduce risk 4

Uterine size equivalent to 16 weeks' gestation or larger significantly increases risk of need for blood transfusion 4
Posterior uterine incision is a significant risk factor for major intraoperative hemorrhage 4

Both laparoscopic and open myomectomy are associated with improved quality of life for up to 10 years 3
Pregnancy is possible after myomectomy, though patients should wait 2-3 months before attempting pregnancy to allow uterine incisions to heal 4
Laparoscopic and open myomectomy have been associated with rare instances of uterine rupture during subsequent pregnancy 2