Intrauterine adhesions after abdominal myomectomy: A systematic review

Abdominal myomectomy is associated with postoperative intrauterine adhesions, which can affect a patient's fertility.

To evaluate the incidence and possible risk factors of intrauterine adhesions after abdominal myomectomy.

A systematic search of PubMed, Embase and Web of Science was undertaken for cohort studies published in peer-reviewed journals up to 19 June 2023. The studies were assessed using the Newcastle-Ottawa scale.

Eleven eligible studies were found. The frequency of postoperative intrauterine adhesions ranged from 1 % to 50 %. Due to the substantial clinical heterogeneity in these studies, a meta-analysis was not feasible. Intrauterine adhesions were seen in 98 of 758 patients overall [12.9 %, 95 % confidence interval (CI) 10.6-15.5]: 9.4 % (95 % CI 6.3-13.5) after minimally invasive surgery and 23.0 % (95 % CI 18.2-28.6) after open abdominal surgery. The adhesions were classified as severe in 34.6 % of cases. Only two studies found correlation between intrauterine adhesions and cavity breach, while four studies could not confirm an association. Fibroid features, such as size, number and submucous type, were found to be a risk factor in three studies. No other unanimous risk factors were identified.

Abdominal myomectomy is associated with intrauterine adhesions. The incidence is probably underestimated and unpredictable, and may be an indication for follow-up hysteroscopy. Further studies are needed to evaluate the incidence, severity and risk factors for intrauterine adhesions after abdominal myomectomy.