Impact of myomectomy on intrauterine adhesions

To assess the incidence and risk factors for intrauterine adhesions following abdominal myomectomy.

This prospective, observational multicenter study included patients undergoing abdominal myomectomy (open or minimally invasive) at two tertiary hospitals in Denmark and one in Norway (March 2021-March 2024). All participants underwent pre- and postoperative mini-hysteroscopy. Surgical details, fibroid characteristics, and perioperative management were recorded. Adhesions were classified according to the American Fertility Society system.

Among the 97 patients enrolled, 87 (89.7%) underwent preoperative hysteroscopy and 71 (73.2%) completed postoperative evaluation. Median age was 34 years (95% CI 29.5-42.5); 33 (48.5%) were nulliparous. Indications included menorrhagia (44.9%), pressure symptoms (60.9%), and infertility (43.5%). Most patients 85.9% had FIGO type 2-5 fibroids, with a median largest fibroid size of 70 mm (95% CI 8-130) and mean distance to endometrium of 3 mm (95% CI 0-19.5). Minimally invasive surgery was performed in 85.9% of cases. At 3-month follow-up, intrauterine adhesions were detected in one patient (1.4%, 95% CI 0.04-7.6%), classified as mild, and successfully treated during mini-hysteroscopy.

In our study the incidence of intrauterine adhesions after abdominal myomectomy was low (1.4%, 95% CI 0.4-7.6%), in contrast to the 1-50% reported in most previous studies. The widespread use of minimally invasive techniques and standardized perioperative care in our study may have contributed to the low risk. Further studies are warranted to confirm our findings and evaluate any impact on reproductive outcomes.