Setting: Nordica Fertility Center, Lagos, Nigeria.
Patients: Thirty-one consecutive Infertile Women (IW) with myomas.
Intervention: Laparoscopic myomectomy.
Main outcome measures: Pattern of myomas, complications, live births.
Results: In all, 139 histologically confirmed myomas were removed from 31 IW (means (±) of age = 38.03 [5.3] and of Body Mass Index = 27.38 [4.6]) during laparoscopic myomectomy (LM) for symptomatic uterine myoma. Infertility was primary and secondary in 13 (41.9%) and in 18 (58.1%) cases respectively and their mean duration of trying to conceive was 5.69 (3.5) years. Six (19.4%) of these women had undergone previous abdominal uterine surgery including LM (2, 6.4%), open myomectomies (3, 9.7%) and appendectomy (1, 3.2%). The range of uterine size was 10-24 weeks. Fibroids were observed more in multiple sites (15, 48.4%) than intramural (10, 32.3%) or sub-serous (4, 12.9%) alone. Two (6.4%) fibroids were exclusively pedunculated. The largest number of fibroid seedlings removed from a patient was 14 and median diameter of the fibroids was 7 cm. Seven (23.0%) patients had post- operative complications two amongst whom had hemorrhagic complications including one hematoma and one excessive hemorrhage warranting conversion to open laparotomy in 1 (3.2%) patient. There was no association between previous abdominal surgeries, body mass index and the rate of complications. Overall mean blood loss was 399 mls (± 338 mls). Three (9.7%) women required post operation blood transfusion. Mean length of hospital stay was 2.77(± 1.43) days. After hysteroscopy at 8 weeks post LM, 14 (45.2%) of these women proceeded to in-vitro fertilization (IVF) treatment and 3 (21.4%) became pregnant and delivered live births, one with twins.
Conclusion: There is relatively low complication rate and short mean duration of hospital stay with LM. Recommendation: Considering the benefits of LM, it is recommended even in low resource settings like ours.
Abayomi Ajayi, Victor Ajayi, Oluwafunmilola Biobaku, Ifeoluwa Oyetunji, Happiness Aikhuele, Oladapo Adejuwon and Bamgboye M Afolabi