Factors Associated with the Complications of Hysteroscopic Myomectomy

Abstract

Objective To evaluate the factors associated with complete myomectomy in a single surgical procedure and the aspects related to the early complications. Methods A cross-sectional study with women with submucous myomas. The dependent variables were the complete myomectomy performed in a single hysteroscopic procedure, and the presence of early complications related to the procedure. Results We identified 338 women who underwent hysteroscopic myomectomy. In 89.05% of the cases, there was a single fibroid to be treated. According to the classification of the International Federation of Gynecology and Obstetrics (Fédération Internationale de Gynécologie et d'Obstétrique, FIGO, in French), most fibroids were of grade 0 (66.96%), followed by grade 1 (20.54%), and grade 2 (12.50%). The myomectomies were complete in 63.31% of the cases, and the factors independently associated with complete myomectomy were the diameter of the largest fibroid (prevalence ratio [PR]: 0.97; 95% confidence interval [95%CI]: 0.96–0.98) and the classification 0 of the fibroid according to the FIGO (PR: 2.04; 95%CI: 1.18–3.52). We observed early complications in 13.01% of the hysteroscopic procedures (4.44% presented excessive bleeding during the procedure, 4.14%, uterine perforation, 2.66%, false route, 1.78%, fluid overload, 0.59%, exploratory laparotomy, and 0.3%, postoperative infection). The only independent factor associated with the occurrence of early complications was incomplete myomectomy (PR: 2.77; 95%CI: 1.43–5.38). Conclusions Our results show that hysteroscopic myomectomy may result in up to 13% of complications, and the chance of complete resection is greater in small and completely intracavitary fibroids; women with larger fibroids and with a high degree of myometrial penetration have a greater chance of developing complications from hysteroscopic myomectomy.

Analysis by literature review with PRISMA 2020 methodology of laparoscopic surgical complications of ovarian cysts

“…Además, se observa que las mujeres con fibromas de mayor tamaño y una mayor penetración en el miometrio tienen un mayor riesgo de desarrollar complicaciones relacionadas con la miomectomía histeroscópica. (9) La histeroscopia ofrece una alternativa mínimamente invasiva para la evaluación de la patología intrauterina y el tratamiento de diversas afecciones, como el sangrado uterino anormal, la infertilidad, las adherencias intrauterinas, las anomalías müllerianas y los cuerpos extraños intrauterinos. Ampliar el acceso a los procedimientos de histeroscopia en el consultorio médico tiene el potencial de mejorar la atención al paciente al reducir las barreras financieras y logísticas, facilitar el diagnóstico y la planificación del tratamiento de manera más eficiente, y posiblemente evitar intervenciones quirúrgicas y anestesia innecesarias.…”

Inversão uterina não puerperal por leiomioma parido: relato de caso

“…Outrossim, miomas localizados na camada uterina intermediária, entre a cavidade interna e o revestimento seroso externo, são nomeados miomas intramurais -os quadros clínicos por eles determinados são complexos e vinculam-se às proporções do nódulo. O crescimento de um mioma intramural pode reclassificá-lo como mioma submucoso ou mioma subserosos, dependendo de onde está localizada a maior porcentagem da massa tumoral (LIMA et al, 2020).…”