Comparison of surgical and obstetric outcomes in women with uterine leiomyomas after laparoscopic vs. abdominal myomectomy: A single-center cohort study

Ordás, Polán; Spagnolo, Emanuela; Fernández, Lucía Gómez-Lavín; Tejeda, María Dolores Diestro; Lafuente, Pilar; Salas, Pilar Carrasco; Carrasco, Ana López; Carbonell, María; Hernández, Alicia

doi:10.3389/fsurg.2022.997078

Cited by 7 publications

(11 citation statements)

References 35 publications

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“…According to current literature, a history of myomectomy furthermore increases the risk of preterm delivery, ranging from 3.1% to 35%, 28 , 35 , 44 , 45 of having a cesarean section at birth, 28 , 31 , 35 , 38 and of suffering from increased blood loss during delivery. 28 , 35 , 46 Additionally, preconceptional myomectomy is associated with a significantly higher risk of placenta accreta compared to a cohort without previous myomectomy, 1.5% vs 0.5%.…”

Section: Discussionmentioning

confidence: 99%

Cystic Adenomyoma in Pregnancy: A Case Report

Verta,

Brambs,

Christmann

2024

IJWH

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Cystic adenomyomas (CA) are rare. They primarily affect adolescents and young women in their fertile years. Therefore, fertility and pregnancy outcome are of pivotal relevance in this patient collective. Apart from the guidelines of the European Society of Human Reproduction and Embryology (ESHRE) on the management of endometriosis in general, there are no specific treatment recommendations for CA and, as far as our research shows, no data illustrating the behavior of a CA over the course of pregnancy. Thus, we report the case of a 32-year-old 1-gravida, 1-para, preconceptionally diagnosed with a CA by ultrasound. After thoroughly discussing further treatment options, the decision was made to opt for a more conservative approach and not perform surgery before attempting a next pregnancy. The patient conceived spontaneously and sonographic monitoring of the CA throughout pregnancy showed complete regression of the cystic component during the second trimester. A healthy baby was delivered at term by an uncomplicated elective cesarean section. Following a review of the literature and taking into account the course of our case, we propose the feasibility of a conservative, non-surgical approach in women with a CA and the desire to conceive.

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Section: Discussionmentioning

confidence: 99%

Cystic Adenomyoma in Pregnancy: A Case Report

Verta,

Brambs,

Christmann

2024

IJWH

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“…Myomectomy was identified as an independent factor contributing to uterine rupture, magnifying the risk by 14 times. [ 22 ] The subsequent pregnancy rate was higher in individuals undergoing laparoscopic myomectomy than in abdominal myomectomy, [ 23 ] although the incidence of uterine rupture during pregnancy was lower after abdominal myomectomy than after laparoscopic procedures. [ 8 ] Hruban et al [ 5 ] reported a 43-year-old tercigravida with a history of laparotomic myomectomy.…”

Section: Discussionmentioning

confidence: 99%

Silent uterine rupture in the term pregnancy: Three case reports

Chen,

Li,

Peng

et al. 2024

Medicine

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Rationale: Uterine rupture is extremely hazardous to both mothers and infants. Diagnosing silent uterine rupture in pregnant women without uterine contractions is challenging due to the presence of nonspecific symptoms, signs, and laboratory indicators. Therefore, it is crucial to identify the elevated risks associated with silent uterine rupture. Patient concerns: on admission, case 1 was at 37 gestational weeks, having undergo laparoscopic transabdominal cerclage 8 months prior to the in vitro fertilization embryo transfer procedure, case 2 was at 38 4/7 gestational weeks with a history of 5 previous artificial abortion and 2 previous vaginal deliveries, case 3 was at 37 6/7 gestational weeks with a history of laparoscopic myomectomy. Diagnoses: The diagnosis of silent uterine rupture was based on clinical findings from cesarean delivery or laparoscopic exploration. Interventions: Case 1 underwent emergent cesarean delivery, revealing a 0.25 cm × 0.25 cm narrow concave area above the Ring Ties with active and bright amniotic fluid flowing from the tear. Case 2 underwent vaginal delivery, and on the 12th postpartum day, ultrasound imaging and magnetic resonance imaging revealed a 5.8 cm × 3.3 cm × 2.3 cm lesion on the lower left posterior wall of the uterus, and 15th postpartum day, laparoscopic exploration confirmed the presence of an old rupture of uterus. Case 3 underwent elective cesarean delivery, revealing a 3.0 cm × 2.0 cm uterine rupture without active bleeding at the bottom of the uterus. Outcomes: The volumes of antenatal bleeding for the 3 patients were approximately 500 mL, 320 mL, and 400 mL, respectively. After silent uterine ruptures were detected, the uterine tear was routinely repaired. No maternal or neonatal complications were reported. Lessons: Obstetricians should give particular consideration to the risk factors for silent uterine rupture, including a history of uterine surgery, such as laparoscopic transabdominal cerclage, laparoscopic myomectomy, and induced abortion.

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“…Some other evidence has suggested that the surgical approach adopted for fibroid removal could have a role in the fertility rate [73]. In this case, the hypothesis is related to the possible enhanced risk of post-operatory adherence after a laparotomic approach, which could interfere with the tubal capability to catch and transport the oocyte to the uterine cavity.…”

Section: Fertilitymentioning

confidence: 91%

“…The reasons for this, depending on the fibroid's position within the uterus, may be associated with endometrial alterations leading to reduced implantation; changes in myometrial muscular fiber contraction; and distortion of pelvic anatomy, including tubes and ovaries [69,70]. As a result, numerous studies have confirmed that after myomectomy, the pregnancy rate increases significantly, reaching up to 50-70% [37,[70][71][72][73]. However, several studies have investigated whether the type of surgical approach could have an impact on fertility rate, but the data are not in accordance among different studies.…”

Section: Fertilitymentioning

confidence: 99%

Exploring Surgical Strategies for Uterine Fibroid Treatment: A Comprehensive Review of Literature on Open and Minimally Invasive Approaches

Cianci,

Gulino,

Palmara

et al. 2023

Medicina

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Background and Objectives: Uterine myomas represent one of the most prevalent pathologies affecting the female population. These benign neoplasms originate from the smooth muscular cells of the uterus, and they can be either single or multiple. Often associated with debilitating symptoms such as pelvic heaviness, pain, constipation, and urinary dysfunctions, the surgical management of myomectomy exhibits considerable variability. This diversity in approaches is influenced by factors such as the number and size of myomas, the patient’s age, and overall clinical conditions. This study aims to elucidate and compare the advantages and disadvantages of different surgical approaches, specifically endoscopic procedures versus open surgery, providing valuable insights for clinical decision making. Materials and Methods: A comprehensive bibliographic search spanning from 2013 to 2023 was systematically conducted across databases including Medline, Embase, the Cochrane Database of Systematic Reviews, and ClinicalTrials.gov. The search utilized keywords such as “myomectomy laparoscopic and open”, “myomectomy open and minimally invasive”, “myomectomy open and laparoscopic”, and “myomectomy open vs. laparoscopic.” The research methodology, along with predetermined inclusion and exclusion criteria, was established prior to the search, ensuring a systematic and rigorous approach. Subsequently, data analysis was carried out. Results: Following the study selection process, 25 articles met the eligibility criteria for inclusion in this analysis. The average numbers of myomas were 3.7 (ranging from 1 to 13.7) and 5.4 (ranging from 1 to 13.5) for the minimally invasive surgery and open surgery groups, respectively. In terms of myoma size, the total averages across studies were 7 cm (ranging from 4.8 to 14) for the minimally invasive group and 8 cm (ranging from 3.9 to 11.2) for the open surgery group. The average pregnancy and delivery rates were 29.7% (ranging from 1.8 to 100) for the minimally invasive group and 28.5% (ranging from 1.8 to 100) for the open surgery group. Regarding complications, the average rate was 14.2% (ranging from 0 to 50) for the endoscopic group and 22.3% (ranging from 0 to 60.3) for the laparotomic group. Conclusions: In conclusion, a critical factor influencing the choice of surgical approach is primarily the size and quantity of fibroids. The mini-laparotomic approach emerges as a viable alternative to endoscopy, demonstrating favorable surgical outcomes and aesthetic results. Interestingly, the type of surgical procedure appears to have no significant impact on the pregnancy rate.

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Comparison of surgical and obstetric outcomes in women with uterine leiomyomas after laparoscopic vs. abdominal myomectomy: A single-center cohort study

Cited by 7 publications

References 35 publications

Cystic Adenomyoma in Pregnancy: A Case Report

Cystic Adenomyoma in Pregnancy: A Case Report

Silent uterine rupture in the term pregnancy: Three case reports

Exploring Surgical Strategies for Uterine Fibroid Treatment: A Comprehensive Review of Literature on Open and Minimally Invasive Approaches

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