Incidence and risk factors of intrauterine adhesions after myomectomy

Bortoletto, Pietro; Keefe, Kimberly W.; Unger, Emily; Hariton, Eduardo; Gargiulo, Antonio R.

doi:10.1016/j.xfre.2022.05.007

Cited by 3 publications

(4 citation statements)

References 21 publications

(25 reference statements)

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“…Major postoperative complications include the formation of intrauterine adhesions. To prevent adhesions, applying anti-adhesion gel or intrauterine devices with oxidized regenerated cellulose and silicon immediately after surgical intervention is suggested [ 73 , 74 , 75 ].…”

Section: Resultsmentioning

confidence: 99%

Currently Available Treatment Modalities for Uterine Fibroids

Micić,

Macura,

Andjić

et al. 2024

Medicina

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Uterine fibroids (leiomyomas and myomas) are the most common benign gynecological condition in patients presenting with abnormal uterine bleeding, pelvic masses causing pressure or pain, infertility and obstetric complications. Almost a third of women with fibroids need treatment due to symptoms. Objectives: In this review we present all currently available treatment modalities for uterine fibroids. Methods: An extensive search for the available data regarding surgical, medical and other treatment options for uterine fibroids was conducted. Review: Nowadays, treatment for fibroids is intended to control symptoms while preserving future fertility. The choice of treatment depends on the patient’s age and fertility and the number, size and location of the fibroids. Current management strategies mainly involve surgical interventions (hysterectomy and myomectomy hysteroscopy, laparoscopy or laparotomy). Other surgical and non-surgical minimally invasive techniques include interventions performed under radiologic or ultrasound guidance (uterine artery embolization and occlusion, myolysis, magnetic resonance-guided focused ultrasound surgery, radiofrequency ablation of fibroids and endometrial ablation). Medical treatment options for fibroids are still restricted and available medications (progestogens, combined oral contraceptives andgonadotropin-releasing hormone agonists and antagonists) are generally used for short-term treatment of fibroid-induced bleeding. Recently, it was shown that SPRMs could be administered intermittently long-term with good results on bleeding and fibroid size reduction. Novel medical treatments are still under investigation but with promising results. Conclusions: Treatment of fibroids must be individualized based on the presence and severity of symptoms and the patient’s desire for definitive treatment or fertility preservation.

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Section: Resultsmentioning

confidence: 99%

Currently Available Treatment Modalities for Uterine Fibroids

Micić,

Macura,

Andjić

et al. 2024

Medicina

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“…Regarding the presence of intrauterine adhesions, this could be a parameter to better understand the complication incidence, but this finding was mentioned only in one of the articles considered in this review. Specifically, they appear to be present in 7.8% of open myomectomy cases and 8.6% of minimally invasive myomectomy cases [32].…”

Section: Comments On Datamentioning

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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“…When the leiomyoma phenotype is not amenable to hysteroscopic surgery, an abdominal approach to myomectomy should be offered, performed laparoscopically, if possible, but only if it is thought to provide optimal fertility outcomes. It should be recognized that intrauterine adhesions may be a consequence of submucous myomectomy, particularly when two or more proximal lesions are removed at the same procedure 103–105 . As a result, strategies to minimize the risk of such an adverse outcome should be considered, from staging hysteroscopic myomectomy into multiple procedures when there are numerous lesions, to using adhesion barriers, to performing second‐look hysteroscopy, at least in high‐risk situations.…”

Section: Specific Therapeutic Applicationsmentioning

confidence: 99%

“…It should be recognized that intrauterine adhesions may be a consequence of submucous myomectomy, particularly when two or more proximal lesions are removed at the same procedure. [103][104][105] As a result, strategies to minimize the risk of such an adverse outcome should be considered, from staging hysteroscopic myomectomy into multiple procedures when there are numerous lesions, to using adhesion barriers, to performing secondlook hysteroscopy, at least in high-risk situations.…”

Section: Myomectomymentioning

confidence: 99%

Therapeutic options for the management of abnormal uterine bleeding

MacGregor

Munro

Lumsden

2023

Intl J Gynecology & Obste

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Just as the investigation of abnormal uterine bleeding (AUB) is approached systematically using the two FIGO systems for AUB in the reproductive years, treatment options can be considered similarly. Therapeutic options fall into two categories—medical and surgical—and while medical management is typically regarded as first‐line therapy, there are several exceptions defined by the presenting cause or causes, mainly when infertility is a concurrent issue. In the early 1990s, up to 60% of women underwent a hysterectomy for the symptom of heavy menstrual bleeding (HMB), but this figure has decreased. The number of women undergoing a hysterectomy for benign disorders continues to decline, along with an increase in hysterectomies performed using minimally invasive techniques. Discussions about therapeutic options are tailored to the individual patient, and we include the risks and benefits of each option, including no management, to enable the patient to make an informed choice. The different types of treatment options and the factors affecting decision‐making are considered in this article.

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Incidence and risk factors of intrauterine adhesions after myomectomy

Cited by 3 publications

References 21 publications

Currently Available Treatment Modalities for Uterine Fibroids

Currently Available Treatment Modalities for Uterine Fibroids

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

Therapeutic options for the management of abnormal uterine bleeding

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