抄録
Objective: A laparoscopic myomectomy (LM) is sometimes repeated because of residual or recurring myomas. The purpose of this study was to examine the characteristics of the cases of repeat LM retrospectively.
Materials and methods: The clinical data of 19 women undergoing a repeat LM among 1,707 cases of LM from January 2005 through August 2012 in our hospital were analyzed. All myomas were diagnosed with a MRI, and LM was performed via the pneumoperitoneum method.
Results: Ten patients (52.9%) were pretreated with a gonadotropin releasing hormone agonist. The average duration between the first and second LMs was 34.2 months (range: 2 to 76 months). The average number of enucleated myomas was 6.1 (range: 1-22) in the first operation and 7.0 (range: 1-23) in the second procedure. In 12 cases, the myomas were almost completely enucleated; however, small remnants may have remained. In contrast, in the other seven cases, we determined that residual myomas resulted in the repeat LM. The main reasons for the residual myomas were: 1) status several myomas in close proximity; 2) myomas not well visualized; and 3) degenerative myomas, which were difficult to discriminate from normal myometrium.
Conclusions: The primary reason for a repeat LM was the unavoidable recurrence of myoma; however, residual myomas were the indication for the reoperation in conditions such as 'myoma complex' and 'degenerative myoma'. In those cases, meticulous surgical technique should reduce the need for a repeat LM.
