Myomectomy: tips for reducing adhesions.(Incisions, Suteres)

SCOTTSDALE, ARIZ. -- A surgeon's method of cutting and stitching during a myomectomy affects the patient's risk for developing adhesions that may obstruct the bowel or reduce her chances of becoming pregnant.

For the best results when performing a myomectomy; make a single transverse incision in the anterior wall of the uterus. After removing the myoma, use a layered suture closure of the myometrial wall, and use a subserosal or baseball stitch to approximate the uterine serosa in a separate layer, Dr. Javier F. Magrina said at an international congress on uterine fibroids.

Single incisions led to fewer uterine and tuboovarian adhesions than did multiple incisions in a 1996 study of myomectomies. A transverse uterine incision parallels the arcuate arteries of the uterus, while a vertical myometrial incision divides the arcuate arteries. Transverse incisions reduce blood loss, said Dr. Magrina, chair of gynecologic surgery at the Mayo Clinic, Scottsdale.

Several studies showed that more adhesions form at the myomectomy incision site and the adnexa after a posterior incision than with incisions at other locations. Posterior incisions also cause more tuboovarian adhesions and reduce pregnancy rates by 40%, compared with anterior or fundal incisions in myomectomies, one ...