Surgical Management of Huge Uterine Fibroids in a Northern Nigerian Teaching Hospital

Abstract

Background: Uterine fibroids are the most common tumor of the uterus worldwide, especially in blacks. While surgery remains the goal standard for definitive treatment, huge uterine fibroids pose a peculiar surgical challenge, with a possibly higher risk of complications such as hemorrhage and deep surgical site infection. Methods: A 5-year retrospective review of patients' folders who had surgical treatment for huge uterine fibroids from January 2015 to December 2019 was done. Huge uterine fibroids were defined as uterine size of ≥16 weeks. The patients' sociodemographic profiles, surgical procedure performed, early and delayed post-operative complications were all documented on a structured proforma. Data was analyzed using SPSS version 21. Results: A total of 245 patients had surgical treatments for uterine fibroids. However, 152 case notes were retrieved, of which 135 had huge uterine fibroids. The mean age of the patients was 37.85 ± 7.05 years. Abdominal myomectomy was performed in 108 (80%) of patients, while others had abdominal hysterectomy. Early post-operative complications included 10 (7.2%) with surgical site infection (SSI), 4 (3%) with febrile morbidity, and 3 (2.2%) requiring blood transfusion. Late complications included 6 (4.4%) with delayed SSI, 5 (3.7%) with uterine synechiae, and 2 (1.5%) with endometritis. There was no peri-operative mortality. Uterine sizes, and type of surgery performed showed no differences in complication rates. Nulliparity, and age <40 years showed higher odds of having myomectomy. Conclusion: The most common surgical treatment for huge uterine fibroids is abdominal myomectomy. Surgical treatment is generally safe with low morbidity.