Chapter 74: PEARS for Uterine Leiomyomata: Myomectomy

Hilgers TW

Reproductive Surgery · Uterine Surgery

Chapter 74: PEARS for Uterine Leiomyomata: Myomectomy

Hilgers TW

The Medical and Surgical Practice of NaProTECHNOLOGY, 1013-1022, 2004

RRM Academy Synopsis

PEARS myomectomy can remove fibroids with reduced adhesion risk

A NaProTECHNOLOGY textbook chapter reports that PEARS myomectomy can remove fibroids with controlled blood loss and a much lower adhesion risk when the surgeon works with care. The chapter on pelvic excision and repair surgery (PEARS) describes diagnosis, indications, and layered repair for women who want to keep their fertility.

Key Findings

Fibroids occur in 20 to 30 percent of women aged 30 to 50, and up to one-third of hysterectomies are done because of them.
The chapter calls the link between fibroids and preterm labor somewhat controversial, citing reported rates of 20 to 30 percent in pregnancies where a myoma was known.
Abnormal presentations, mostly breech and otherwise transverse, are the most common pregnancy complication of myomas, reported in 37 percent of cases involving fibroids of significant size.
Physical examination detects only 40 percent of fibroids, and the chapter names ultrasound by a skilled sonographer as the most accessible diagnostic tool.
A life table analysis estimates the 10-year recurrence rate after myomectomy at 27 percent, with risk rising as more fibroids are removed.

RRM Context

Pelvic excision and repair surgery is the surgical method of NaProTECHNOLOGY. Restorative reproductive medicine values operations that protect the organs a woman needs for conception and childbearing. Surgery is planned around her symptoms, her health, and her goals for a family. The chapter advises laparotomy when future reproduction is intended, so that the surgeon can close the uterine wall in layers and protect the outer surface. Layered closure aims to leave a uterus able to support a later pregnancy.

Our editorial summary of this paper, not the article's abstract.

Abstract

This chapter reviews uterine leiomyomata (fibroids), their position in the uterine wall, their possible effects on fertility and pregnancy, and their diagnosis, which the author finds most readily available by transvaginal and abdominal ultrasound in the hands of a skilled sonographer. From a fertility point of view, the chapter does not recommend laparoscopic myomectomy and recommends laparotomy so that meticulous surgical technique can be used, citing reported risks of fistula formation and uterine rupture with the laparoscopic approach. Indications for myomectomy are listed, and the PEARS technique is illustrated for deep intramural and pedunculated fibroids, with a CO2 laser incision, a layered closure of the myometrium and an imbricating 4-0 Prolene closure of the serosa. Describing standard myomectomy as a very adhesiogenic procedure, the chapter describes adhesion prevention with Hyskon, Interceed TC-7 and Gore-Tex surgical membrane and reports that the overall 10-year recurrence rate of fibroids has been estimated at 27 percent.

Topics

Reproductive Surgery › Uterine Surgery › Myomectomy · Uterine and Pelvic Conditions › Fibroids › Fibroid Management · Infertility › Uterine Factor › Fibroids and Polyps

Thomas W Hilgers

Tom Hilgers, T Hilgers

Hilgers et al. 2004, Hilgers 2004

Chapter 74: PEARS for Uterine Leiomyomata: Myomectomy

PEARS myomectomy can remove fibroids with reduced adhesion risk

Key Findings

RRM Context

Abstract

Topics

By this author

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