Prevalence of Intrauterine Adhesions after Myomectomy: A Prospective Multicenter Observational Study

Abstract

Objectives: To evaluate intrauterine adhesion formation after laparoscopic and laparotomic myomectomy. Design: Prospective, multicenter, observational study (ClinicalTrials.gov ID: NCT04030273). Methods: We included patients after laparotomic and laparoscopic myomectomy. All patients underwent post-surgical diagnostic hysteroscopy, after three months. The intrauterine adhesion rate and associated factors were investigated. Results: Between January 2020 and December 2020, 38 and 24 consecutive patients underwent laparoscopic and laparotomic myomectomy, respectively. All diagnostic hysteroscopies were performed in the office setting without complications. Intrauterine adhesions were identified in 19.4% of women (95% CI of 9 – 29%). Factors univariately associated (p <0.2) with the presence of intrauterine adhesions after myomectomy were previous uterine surgery, the surgical approach (laparoscopic or laparotomic), the number of removed fibroids, the type and diameter of the largest myoma, and the opening of the uterine cavity. In the multivariable analysis, only the opening of the uterine cavity (OR 51.99; 95% CI, 4.53 – 596.28) and the laparotomic approach (OR, 16.19; 95% CI, 1.66 – 158.35) were independently associated with the identification of intrauterine adhesions after myomectomy. Limitations: One of the main limitations of our study is that we used uterine manipulator only in laparoscopic group; in addition, we did not perform a pre-operative hysteroscopy to evaluate the rate of intrauterine adhesions potentially present even before the myomectomy. Conclusions: The prevalence of intrauterine adhesions after three months from surgery was significantly associated with the opening of the uterine cavity and the laparotomic approach.

Transvaginal natural orifice endoscopic surgery for myomectomy: Can it be a conventional surgery?

“…There was no special cause of intraoperative bleeding, except that the uterine fibroids were all larger than 8 cm in size, and even one patient had a fibroid of 15 cm. Previous studies have shown that when the diameter of fibroid was relatively large, the blood loss in the multiport group was less than that of the LESS group (43,44). Despite the excessive bleeding, there was no transfer to other operations and the surgery was continued and completed safely.…”

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

“…In a recent review ( 32 ), oxidized regenerated cellulose was found to be effective in reducing the total adhesion score during second-look surgery. Laganá et al ( 33 ) showed that the opening of uterine cavity and the laparotomic approach represented independent risk factors for developing intrauterine adhesions, after 3 months from surgery.…”

Incidence and risk factors of intrauterine adhesions after myomectomy

“…For example, we were not able to study the impact of the size, number, and depth of penetration of fibroids on the incidence of postoperative adhesions. Published adhesion rates after HM have been described in the range of 7.5%– 20% ( 10 , 21 ); likewise, the rare studies investigating IUA after open myomectomy and minimally invasive myomectomy were 19%–25.1% and 21%, respectively ( 13 , 22 , 23 ). The lower rate of adhesions found in our surgical patient population may reflect technical excellence in a high-volume subspecialized reproductive surgery practice, or could have occurred by chance, owing to the low percentage of cases with second-look information.…”