The operator should therefore never undertake the operation of salpingo-oöphorectomy for uterine fibroid unless he is prepared to perform hysterectomy if this operation is found necessary.
Hysterectomy is deservedly the favorite operation for uterine fibroids at the present day.
The danger of the operation is small, being but little, if any, greater than that attending salpingo-oöphorectomy for fibroids, if we compare only those cases in which either operation may be performed.
The operation is applicable to every kind of fibroid tumor. The relief of symptoms is immediate and certain.
The reflex symptoms, such as backache and headache, which are directly due to the pathological condition of the uterus, often disappear immediately and permanently. This cannot be said of salpingo-oöphorectomy, after which operation these symptoms often continue for an indefinite period.
The treatment of uterine fibroids has followed in development the growth of abdominal and pelvic surgery. In the days when celiotomy was a dangerous operation the palliative treatment was advisable. When salpingo-oöphorectomy could be safely performed this treatment was practised; and now that hysterectomy is equally safe, it has become the operation of election.
The details of the operation of hysterectomy for uterine fibroids will be considered in a subsequent chapter.
Myomectomy (Abdominal).—In some cases of uterine fibroid it is possible to remove the tumor without taking away the uterus. This operation, when performed through an abdominal incision, is called abdominal myomectomy. From a surgical standpoint it is the ideal plan of treatment, as the woman is cured of the disease without suffering mutilation.
Myomectomy is especially adapted to the treatment of single fibroid tumors which may be excised or shelled out of the body of the uterus. It is indicated in the case of young women who are anxious for children.
The field of myomectomy is at present a limited one. Single subperitoneal and interstitial fibroid tumors are rare. Even though the secondary nodules may be small at the time of operation, they will grow after the removal of the chief mass. Hysterectomy has been required at a second operation in a woman on whom myomectomy had been first performed.