Recurrence of leiomyomata after myomectomy

Abdominal myomectomy (by laparotomy or by laparoscopy) enables all the myom ata to be excised while maintaining reproductive function, The actual risk of recurrence after abdominal myomectomy is difficult to assess because of methodological problems, Studies using life-table analysis find a cumulativ e risk of clinically significant recurrence of similar to 10% at 5 years fo r myomectomy by laparotomy. This risk probably underestimates the true prev alence of myomata as assessed by systematic ultrasound investigation, After laparoscopic myomectomy there appears to be a greater risk of recurrence, In one third of cases, recurrence becomes the reason for a hysterectomy. Th e risk of recurrence increases when there is more than one myoma. The use o f gonadotrophin-releasing hormone agonists preoperatively could increase th e risk of recurrence, Persistence or recurrence of the myoma thus reduces t he chances of conception or taking a pregnancy full term after the myomecto my. It is essential to obtain the most complete exeresis possible in order to reduce the risk of recurrence to a minimum. However, it is inevitable th at small, undetectable nuclei will remain within the myometrium whatever ap proach is used (laparoscopy or laparotomy), It would be an advantage to kno w what the growth factors are and how to identify groups at high risk of re currence so that the treatment strategies could be better adapted and appro priate prophylactic methods developed.