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    Tool helps with decision-making for fibroid management

     

    The tool was applied to a hypothetical population of 20,000 patients with large uterine fibroids, of whom 10,000 underwent laparoscopic hysterectomies and 10,000 had abdominal hysterectomies. The authors calculated that abdominal hysterectomy would result in 50.1% more adhesions, 10.7% more hernias, 4.8% more surgical site infections, 2.8% more bowel obstructions, and 2% more VTEs than laparoscopic hysterectomy. An abdominal procedure also would result in longer hospital stays (2 days), slower return to work (13.6 days), greater postoperative day 3 narcotic requirements (48%), and lower SF-36 QoL scores (50.4 points lower).

    Looking at risks associated with unsuspected cancers, the authors estimated that 0.28% of patients undergoing hysterectomy for fibroids would have occult uterine sarcomas. In these women, laparoscopic hysterectomy with morcellation would reduce 5-year overall survival rates by 27% and recurrence-free survival by 28.8 months. Because it is not possible to exclude the presence of an occult malignancy with imaging or statistical models, physicians should use their clinical judgment and consider contained tissue extraction at the time of surgery.

    Judith M. Orvos, ELS
    Judith M. Orvos, ELS, is a a BELS-certified medical writer and editor and an editorial consultant for Contemporary OB/GYN.

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