RELATIVE MORBIDITY OF ABDOMINAL HYSTERECTOMY AND MYOMECTOMY FOR MANAGEMENT OF UTERINE LEIOMYOMAS

Objective: To compare the morbidity of total abdominal hysterectomy an d abdominal myomectomy in the surgical management of uterine leiomyoma s. Methods: Hospital records were reviewed for ail women who underwent hysterectomy (n = 89) or myomectomy (n = 103) between May 1, 1988, an d May 1, 1993, for the preoperative diagnosis of leiomyoma. Results: T here were significant differences between the two groups for average a ge (hysterectomy 39.2 years, myomectomy 34.4 years; mean difference 4. 8, 95% confidence interval [CI] of difference 3.7-5.9), uterine size ( hysterectomy 15.2, myomectomy 11.5 weeks; mean difference 3.8, 95% CI of difference 2.0-5.4) and use of a GnRH agonist (hysterectomy 23.6%, myomectomy 55.3%; relative risk [RR] 0.4, 95% CT 0.3-0.6). Myomectomy was associated with decreased estimated blood loss (hysterectomy 796 m L, myomectomy 464 mL; mean difference 331, 95% CI 121-542) and febrile morbidity (risk of temperature 38C or 48 or more hours postoperativel y: for hysterectomy 49.4%, for myomectomy 32%; RR 1.5, 95% CI 1.1-2.2) . Using multivariate linear regression, estimated blood loss was simil ar between the groups after controlling for uterine size. There was no difference in blood transfusion rates. There were two ureteral, one b ladder, one bowel, and one femoral nerve injury in the hysterectomy gr oup, and there were no intraoperative visceral injuries in the myomect omy group. Conclusion: Myomectomy compares favorably to hysterectomy i n the surgical management of leiomyomas, with a possible decreased ris k for visceral injury and infection.