A new approach to treating uterine fibroids — combining myomectomy and uterine artery ligation — has eliminated the recurrence of fibroids in a new study, and the procedure was also more effective at relieving menstrual pain and heavy bleeding than either procedure alone, report doctors in Taiwan.
"A uterine depletion procedure followed by myomectomy, by either abdominal or laparoscopic route, is a promising advance in the treatment of symptomatic fibroids," the researchers report.
The procedure also has the advantage of preserving the uterus and can preserve future reproductive capacity, unlike hysterectomy.
A study of the new procedure was conducted by doctors at hospitals in Taipei, Taiwan and is published in the July issue of the journal Fertility and Sterility.
Doctors enrolled 342 women with uterine fibroids and symptoms that warranted surgery. Symptoms included menorrhagia, which is heavy or prolonged bleeding, and dysmenorrhea, which are painful menstrual cramps. The women were all between the ages of 24 and 49 years.
At the time of the study, there was little data available regarding preservation of fertility and uterine function when combining these procedures to treat fibroids. Therefore, women who were unwilling to receive the combined treatment were placed in the control group – Group 1. The women who indicated they were not planning future pregnancies and were willing to undergo the combined treatments were placed in Group 2.
In both groups, myomectomy was done either abdominally, that is through an incision in the abdomen, or laparoscopically. Patients with smaller and fewer fibroids received the less-invasive laparoscopic approach. During myomectomy, the surgeon removes each fibroid from the woman’s uterus.
Prior to myomectomy, patients in Group 2 first underwent uterine depletion — that is ligation or clamping of the uterine arteries to restrict blood flow to the uterus. Without blood flowing to the fibroids, the tumors eventually shrink and disappear. This made Group 2’s operating time 13 minutes longer than the women’s in Group 1.
All patients were followed for an average of about 26 months. In Group 1, nearly 82% of the women said their symptoms were resolved after surgery. In Group 2, nearly 99 % of women experienced resolution of their symptoms. And of all the women in Group 2 who had menorrhagia, 100% of them said their heavy bleeding had stopped.
Surgical blood loss was also significantly lower in the combined procedure group, and this group had a slightly shorter length of hospital stay. The difference in hospital stay was largely affected by whether the myomectomy was performed abdominally or laparoscopically. The laparoscopic procedure decreased length of stay by almost 2 days.
After 25 months, no patient in Group 2 had experienced a recurrence of fibroids, but more than 19% of the women in Group 1 had fibroids diagnosed post-operatively.
"For the women in our study, all large visible fibroids were removed by surgery while the small, concealed fibroids were treated by the uterine depletion procedure, resulting in a 100% success rate," the researchers report.
Recurrence was associated with the number of fibroids prior to surgery. Patients with no recurrent fibroids had an average of 2 tumors before the procedure. Women who did develop recurrent fibroids had more than 4 tumors prior to surgery.
By performing the ligation method prior to myomectomy, the researchers believe they destroy the "small, concealed, seeding fibroids that would later become symptomatic." But they added that longer follow-up of these patients is necessary to prove that theory correct.
Pregnancy remained possible after ligation of the uterine arteries, with 21 of 40 sexually active women becoming pregnant and 15 of those women having live births. In comparison, 58 of 98 women in Group 1 who were attempting conception became pregnant, and 49 of those women delivered live babies.
And while they found no evidence of maternal or fetal complications, the authors reported that, "Larger studies to investigate fecundity and pregnancy-related complications (including intrauterine growth restriction) after uterine depletion and myomectomy are needed."