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Archives of Gynecology and Obstetrics

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01-03-2015 | General Gynecology

Laparoscopic treatment of uterine fibroids: a comparison of peri-operative outcomes in laparoscopic hysterectomy and myomectomy

Authors: F. Odejinmi, Kate Maclaran, Nilesh Agarwal

Published in: Archives of Gynecology and Obstetrics | Issue 3/2015

Abstract

Purpose

To compare peri-operative outcomes between laparoscopic myomectomy (LM) and laparoscopic hysterectomy (LH) for the treatment of uterine fibroids.

Methods

Retrospective cohort study including 400 women who underwent LH or LM for the management of uterine fibroids.

Results

LH patients were older, with higher BMI and larger uterine size but LH was associated with shorter operative duration (80.2 vs. 115.7 min, p < 0.0001), lower blood loss (215 vs. 316 ml, p < 0.0001), and shorter hospital stay (1.81 vs. 2.12 days, p = 0.0003). Seven LM patients (3.2 %) had blood loss >1000 ml compared with no LH patients and five LM patients (2.3 %) required blood transfusion compared to 1 (0.5 %) LH patient. Three LM patients (1.9 %) and no LH patients required conversion to laparotomy. Bladder injury occurred in three LH cases (1.6 %) and no LM cases. When the data was restricted only to women aged 44 years or over, LH was again associated with significantly lower operative duration and estimated blood loss.

Conclusions

Particularly in perimenopausal women, the decision to perform myomectomy can be controversial. These data suggest that there are potential advantages to LH over LM, including reduced operation length, blood loss and hospital stay but increased risk of urinary tract injury.

Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM (2003) High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 188:100–107PubMedCrossRef

Istre O (2008) Management of symptomatic fibroids: conservative surgical treatment modalities other than abdominal or laparoscopic myomectomy. Best Pract Res Clin Obstet Gynaecol 22:735–747PubMedCrossRef

Levy BS (2008) Modern management of uterine fibroids. Acta Obstet Gynecol Scand 87:812–823PubMedCrossRef

Okolo S (2008) Incidence, aetiology and epidemiology of uterine fibroids. Best Pract Res Clin Obstet Gynaecol 22:571–588PubMedCrossRef

Whiteman MK, Hillis SD, Jamieson DJ, Morrow B, Podgornik MN, Brett KM, Marchbanks PA (2008) Inpatient hysterectomy surveillance in the United States, 2000–2004. Am J Obstet Gynecol 198(34):e1–e7PubMed

Elahi SM, Odejinmi F (2008) Overview of current surgical management of fibroids: organ-preserving modalities. J Obstet Gynaecol 28:28–31PubMedCrossRef

Sawin SW, Pilevsky ND, Berlin JA et al (2000) Comparability of perioperative morbidity between abdominal myomectomy and hysterectomy for women with uterine leiomyomas. Am J Obstet Gynecol 183:1448–1455PubMedCrossRef

Nieboer TE, Johnson N, Lethaby A, Tavebder E, Curr E, Garry R, van Voorst S, Mol BW, Kluivers KB (2009) Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev (3):CD003677. doi: 10.1002/14651858.CD003677.pub4

Shahid A, Sankaran S, Odejinmi F (2011) Laparoscopic subtotal hysterectomy for large uteri using modified five port technique. Arch Gynecol Obstet 283:79–81PubMedCrossRef

10.

Sankaran S, Odejinmi F (2013) Prospective evaluation of 125 consecutive laparoscopic myomectomies. J Obstet Gynaecol 33:609–612PubMedCrossRef

11.

Hussain M, Odejinmi F (2012) Laparoscopic supracervical hysterectomy: impact of body mass index and uterine weight. Gynecol Surg 9:351–355CrossRef

12.

Wallwiener M, Taran FA, Rothmund R, Kasperkowiak A, Auwärter G, Ganz A, Kraemer B, Abele H, Schönfisch B, Isaacson KB, Brucker SY (2013) Laparoscopic supracervical hysterectomy (LSH) versus total laparoscopic hysterectomy (TLH): an implementation study in 1,952 patients with an analysis of risk factors for conversion to laparotomy and complications, and of procedure-specific re-operations. Arch Gynecol Obstet 288:1329–1339PubMedCrossRef

13.

Siedhoff MT, Carey ET, Findley AD, Riggins LE, Garrett JM, Steege JF (2012) Effect of extreme obesity on outcomes in laparoscopic hysterectomy. J Minim Invasive Gynecol 19:701–707PubMedCrossRef

14.

Bonilla DJ, Mains L, Whitaker R, Crawford B, Finan M, Magnus M (2007) Uterine weight as a predictor of morbidity after a benign abdominal and total laparoscopic hysterectomy. J Reprod Med 52:490–498PubMed

15.

Carter JE, McCarus S, Baginiski L, Bailey TS (1996) Laparoscopic outpatient treatment of large myomas. J Am Assoc Gynecol Laparosc 3(4 Suppl):S6

16.

Perron-Burdick M, Yamamoto M, Zaritsky E (2011) Same-day discharge after laparoscopic hysterectomy. Obstet Gynecol 117:1136–1141PubMedCrossRef

17.

Lemyre M, Bujold E, Lathi R, Bhagan L, Huang JQ, Nezhat C (2012) Comparison of morbidity associated with laparoscopic myomectomy and hysterectomy for the treatment of uterine leiomyomas. J Obstet Gynaecol Can 34:57–62PubMed

18.

Radosa MP, Winzer H, Mothes AR, Camara O, Diebolder H, Weisheit A, Runnebaum IB (2012) Laparoscopic myomectomy in peri- and post-menopausal women is safe, efficacious and associated with long-term patient satisfaction. Eur J Obstet Gynecol Reprod Biol 162:192–196PubMedCrossRef

19.

Gendy R, Walsh CA, Walsh SR, Karantanis E (2011) Vaginal hysterectomy versus total laparoscopic hysterectomy for benign disease: a metaanalysis of randomized controlled trials. Am J Obstet Gynecol 204:388.e1–388.e8CrossRef

20.

Sesti F, Cosi V, Calonzi F, Ruggeri V, Pietropolli A, Di Francesco L, Piccione E (2014) Randomized comparison of total laparoscopic, laparoscopically assisted vaginal and vaginal hysterectomies for myomatous uteri. Arch Gynecol Obstet. doi:10.1007/s00404-014-3228-2 PubMed

21.

Twijnstra AR, Blikkendaal MD, van Zwet EW, van Kesteren PJ, de Kroon CD, Jansen FW (2012) Predictors of successful surgical outcome in laparoscopic hysterectomy. Obstet Gynecol 119:700–708PubMedCrossRef

22.

Wallenstein MR, Ananth CV, Kim JH, Burke WM, Hershman DL, Lewin SN, Neugut AI, Lu YS, Herzog TJ, Wright JD (2012) Effect of surgical volume on outcomes for laparoscopic hysterectomy for benign indications. Obstet Gynecol 119:709–716PubMedCrossRef

23.

Khan AT, Shehmar M, Gupta JK (2014) Uterine fibroids: current perspectives. Int J Womens Health 6:95–114PubMedCentralPubMedCrossRef

Title: Laparoscopic treatment of uterine fibroids: a comparison of peri-operative outcomes in laparoscopic hysterectomy and myomectomy
Authors: F. Odejinmi
Kate Maclaran
Nilesh Agarwal
Publication date: 01-03-2015
Publisher: Springer Berlin Heidelberg
Published in: Archives of Gynecology and Obstetrics / Issue 3/2015
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-014-3434-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Laparoscopic treatment of uterine fibroids: a comparison of peri-operative outcomes in laparoscopic hysterectomy and myomectomy

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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