Reproductive Outcomes following Use of Barbed Suture during Laparoscopic Myomectomy

Abstract

To review pregnancy outcomes after laparoscopic myomectomy with the use of barbed suture. Design: Retrospective cohort study and follow-up survey. Setting: Single, large academic medical center. Patients: Patients who underwent laparoscopic myomectomy with the use of barbed suture for myometrial closure between 2008 and 2016. Intervention: Laparoscopic myomectomy and a follow-up survey regarding pregnancy outcome. Measurements and Main Results: A total of 486 patients met inclusion criteria and underwent a laparoscopic myomectomy between 2008 and 2016. Of the 428 with viable contact information, 240 agreed to participate (56%). Of those who responded to the survey, 101 (42%) attempted to get pregnant, and there were 4 unplanned pregnancies. There were 110 pregnancies among 76 survey respondents. In total, of the women attempting a postoperative pregnancy, 71% had at least 1 pregnancy. Comparing the women who did and did not conceive postoperatively, the group who got pregnant was on average younger, 33.8 § 4.5 years vs 37.5 § 6.5 years (p = .001); had fewer myomas removed, median = 2 (range 1-9) vs median = 2 (range 1-16) myomas (p = .038); and had a longer follow-up period, 30 months ( vs 30 (11-93 months) § 20 (p <.001). The mean time to first postoperative pregnancy was 18.0 months (range 2−72 months). Of the 110 reported postoperative pregnancies, there were 60 live births (55%), 90% by means of cesarean section. The mean gestational age at birth was 37.8 weeks. In the cohort, there were 8 preterm births, 3 cases of abnormal placentation, 2 cases of fetal growth restriction, 3 cases of hypertensive disorders of pregnancy, and 2 cases of myoma degeneration requiring hospitalization for pain control. There were no uterine ruptures reported. Conclusion: According to our findings, pregnancy outcomes after laparoscopic myomectomy with barbed suture are comparable with available literature on pregnancy outcomes with conventional smooth suture.

Laparoscopic myomectomy – The importance of surgical techniques

“…As the authors concluded, the available data regards patients with previous barbed suture, lacking information about fertility outcomes in control groups. Considering barbed suture outcomes, pregnancy rates of 71% have been reported ( 61 ), similar to other studies that evaluated laparoscopic myomectomy without differentiation ( 17 , 62 ). Cesarean sections were performed frequently, and the reported complications included preterm birth, abnormal placentation, hypertensive disorders, growth restriction, and myoma degeneration (18 of 110 pregnancies) ( 61 ).…”

Recent advances in benign gynecological laparoscopic surgery

“…In regard to the effect of barbed sutures on fertility and pregnancy after myomectomy, a recent retrospective cohort study and follow-up survey by Pepin et al . 55 showed that pregnancy outcomes after laparoscopic myomectomy with barbed suture are comparable to the available literature on pregnancy outcomes with conventional smooth sutures, making the former safe to use in procedures that are indicated to improve fertility and obstetrical outcomes.…”

Successful myomectomy using barbed sutures at 15 weeks of gestation: A case report

“…A retrospective cohort study reported no uterine ruptures in 110 pregnancies, following laparoscopic myomectomy using barbed sutures before pregnancy [ 9 ]. Perinatal outcomes in myomectomy during pregnancy using barbed sutures are unclear, as there are no other reported cases using the same sutures.…”