Uterine fibroid: Clinical presentation and relative morbidity of abdominal myomectomy and total abdominal hysterectomy, in a teaching hospital of Karachi, Pakistan

Objective: To compare clinical presentation and morbidity of abdominal myomectomy and hysterectomy. Methods: We reviewed medical records of 441 patients with symptomatic fibroid, treated by myomectomy (135) or hysterectomy (306) at The Aga Khan University Hospital, Karachi, from January 1991 to December 1995. Z-test and risk estimates with 95% confidence intervals were calculated. Results: Pregnancy loss [Risk Ratio = 2.79, 95% Confidence Interval= 1.90 - 4.10], pelvic mass [Risk Ratio = 2.22, 95% Confidence Interval = 1.68 - 2.92] and infertility [Risk Ratio = 1.44, 95% Confidence Interval = 1.05-1.96] were more likely to be managed by myomectomy than in the absence of these complaints. Abnormal uterine bleeding was less likely to be treated by myomectomy than in its absence [Risk Ratio = 0.54, 95% Confidence Interval = 0.41 - 0.71]. With myomectomy, both the estimated mean intra-operative blood loss and the risk of febrile morbidity were significantly less than with hysterectomy [Mean (S.D.): 386 milliliters (48) versus 567 milliliters (62), p-value 0.000 and Risk Ratio = 0.37, 95% Confidence Interval = 0.16 - 0.87, respectively]. The risk of visceral injury [Risk Ratio = 2.24,95% Confidence Interval = 0.74 - 6.82], blood transfusion [Risk Ratio = 0.69, 95% Confidence Interval = 0.44 - 1.07], mean duration of operating time [Mean (S.D.) 127 minutes (35) versus 131 minutes (47), p-value 0.93] and mean duration of hospital stay [Mean (S.D.): 5.44 days (1.28) versus 5.42 days (1.09), p-value 0.92] did not differ significantly between the groups. Conclusion: Myomectomy can be considered as a safe alternative to hysterectomy for the surgical management of uterine fibroids, with an added advantage of preservation of women's sexual and reproductive functions.