HYSTERECTOMY AND MYOMECTOMY BY LAPAROTOMY

Hysterectomy provides definitive treatment for uterine fibroids. Surge ry should be offered to women whose fibroids are symptomatic; it is no t indicated on the basis of uterine size alone. Myomectomy is an optio n for those wishing to preserve uterine function. The prospects for su ccessful pregnancy following myomectomy are encouraging, although ther e is a significant risk of the later recurrence of fibroids. Laparotom y remains the most appropriate surgical approach for large fibroids, a lthough vaginal, rather than abdominal, hysterectomy may be suitable f or some women whose uteri do not exceed a 12-14 week gestation size. T here is some evidence that the morbidity of abdominal procedures incre ases with very large uteri. Uterine shrinkage with GnRH analogues may facilitate vaginal hysterectomy and be useful prior to abdominal hyste rectomy or myomectomy for very large fibroids, although cost-effective ness for its use with abdominal procedures has not been demonstrated.