Pregnancy outcomes following different surgical approaches of myomectomy

The aim of this study was to compare the feasibility, reliability, safety and pregnancy outcomes following transabdominal myomectomy (TAM) and laparoscopic myomectomy (LM) at Beijing Obstetrics and Gynecology Hospital.

The study included two parts: between January 2005 and December 2010, data on 157 patients were retrospectively collected; and between January 2011 and January 2013, 111 patients were prospectively collected. All of them had fertility requirements following myomectomy. Patients' demographics, leiomyomas' characteristics, perioperative data regarding surgical complications, relapses, subsequent pregnancy outcomes and obstetric characteristics were collected.

The patients' demographics and leiomyoma characteristics were comparable in the TAM and LM groups (P > 0.05). There was no significant difference in the average drop in hemoglobin between the two groups (P = 0.887), while the postoperative ileus duration, postoperative ambulation duration and dose of analgesia were significantly higher in the TAM group (P < 0.001). There was no significant difference in the overall relapse and subsequent cumulative pregnancy rates and obstetric complications between the two groups. The contraception interval after myomectomy was significantly longer (P = 0.038) after TAM, however the cesarean section rate only due to myomectomy history was higher (P = 0.034) after TAM than after LM. Four patients in the LM group were identified as having uterine scar defective repair on the site of the previous myomectomy scar during elective cesarean section, while this was not identified in any patient in the TAM group.

LM is a feasible treatment for women who have fertility requirements but suffer from leiomyoma. Although LM does not increase the rate of uterine rupture in the subsequent pregnancy, it is advisable for surgeons to limit the use of electrosurgery.