Myomectomy Benefits, Risks, Long-Term Outcomes, and Effects on Fertility and Pregnancy Outcomes: A Literature Review

Objective: Abdominal myomectomy is the mainstay for women with intramural fibroids who want to conceive. Informed choice, discussion on alternatives, and consent for surgery are essential prior to the procedure. Women with fibroids need to understand the potential long-term complications and future implications, including the effects of fibroids or myomectomy on fertility and pregnancy outcomes. This article offers evidence-based information for informing women about the consequences and benefits of myomectomy and other treatments. Methods: Using thesaurus terms, articles in English since 2012, on PubMed, Embase (OVID), and MEDLINE® (ProQuest) databases were retrieved via the National Institute for Health and Care Excellence Healthcare Databases Advanced Search interface. Myomectomy outcomes, risks, complications, fertility, and rare complications later in pregnancy were reviewed. Results: Ninety-two articles were chosen. They covered topics relevant to this review. Duplicate articles, those not related to this review, or with low numbers of cases in retrospective studies were excluded. When fibroids affect reproductive age women, myomectomy's surgical and reproductive outcomes have significant benefits, compared to relatively severe but uncommon complications. Myomectomy-related long-term reintervention is higher than for hysterectomy, but short-term outcomes for pain and bleeding are comparable to hysterectomy. Conclusions: Myomectomy (laparoscopic or open) is safe. Benefits are greatest for reproductive-age women with fibroids. Surgical and reproductive outcomes of myomectomy have benefits, compared to relatively few severe but uncommon complications. This review article of all the potential benefits, risks, and complications can help surgeons inform patients appropriately and reduce potential litigation. (J GYNECOL SURG 39:151)