Question: Hi, please find the below details of a case. i need to kindly know if Total Laparoscopic Hysterectomy with bilateral Salpingo-oophorectomy or only Myomectomy only is recommended and which one is with the best outcome as per this patient

A 49-years old female presented with complains of severe abdominal pain.

The patient came to Out-Patient Department on 12th April 2015 with complaints of severe abdominal pain since 2 weeks. Her menstrual history consists for regular periods, with heavy flow. However, from the past three months, there is irregular and heavy bleeding. She also had one month of continuous bleeding in December 2014.

She is Para 4, all full term normal deliveries. There is no history of any other relevant surgical or medical history in the past. In view of the severe menorrhagia with hyperplastic endometrium, she underwent a Dilatation & Curettage (D&C) on 21st April 2015, and endometrial biopsy was done, which showed no evidence of hyperplasia or malignancy. The member reported again in the clinic with complaints of lower abdominal pain on 28th April 2015.

In view of the multiple fibroids causing severe menorrhagia and abdominal pain, the patient is advised to undergo total laparoscopic hysterectomy with bilateral salpingo-oophorectorny at the earliest.

Clinical Examination
On examination, the uterus is found to be enlarged to 10 weeks' in size, irregular in
shape with tenderness in the fornices.

Past medical/surgical history
Nothing Significant.


Trans-Vaginal Ultrasound (12.04.2015):
•     Uterus is anteverted, enlarges to 10 x 7 cm.
•     There are multiple uterine fibroids all over the uterus, intramural and subserous, with size 4 x 5, 3 x 5 and 3 x 4 cm.
•     Endometrial cavity was thickened 2 x 2 cm.
•     Ovaries appeared normal.
•     Impression: Multiple Fibroids with Endometrial Hyperplasia

Trans-Vaginal Ultrasound (28.04.2015): Post D&C
•     Uterus is anteverted, enlarges to 10.2 x 8.5 cm.
•     There are multiple uterine fibroids all over the uterus
•     Ovaries appeared normal.
•     Impression: Multiple Fibroids

Endometrial Biopsy:
•     Site of specimen: Endometrial
•     Gross Description: Received in formalin, labelled with the patient's name and number and designated on the container as from "Endometrial curettings", consists of multiple irregular grey brown to dark brown focally haemorrhagic soft pieces of tissue with blood clots measuring 1.0xO.6xO.2 cm. The specimen is entirely submitted in one cassette.
•     Interpretation: Endometrial tissue, clinically from "Endometrium", curetting:
o     Focal secretory endometrium with polypoid fragments of dilated, crowded endometrial glands, decidulaized stroma and thick-walled blood vessels, most consistent with endometrial polyp.
o     No evidence of hyperplasia or malignancy identified.