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Volume 13, Issue 3 (3-2015)
IJRM 2015, 13(3): 161-168 |
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Asgari Z, Hafizi L, Hosseini R, Javaheri A, Rastad H. Intrauterine synechiae after myomectomy; laparotomy versus laparoscopy: Non-randomized interventional trial. IJRM 2015; 13 (3) :161-168
URL: http://ijrm.ir/article-1-630-en.html
URL: http://ijrm.ir/article-1-630-en.html
1- Department of Gynecologic Laparoscopy, Arash Women’s Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
2- Department of Obstetrics and Gynecology, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran , hafizil@mums.ac.ir
3- Department of Obstetrics and Gynecology, Faculty of Medicine, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
4- Research Development Center, Arash Women’s Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
2- Department of Obstetrics and Gynecology, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran , hafizil@mums.ac.ir
3- Department of Obstetrics and Gynecology, Faculty of Medicine, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
4- Research Development Center, Arash Women’s Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Abstract: (3161 Views)
Background: Leiomyomata is the most frequent gynecological neoplasm. One of the major complications of myomectomy is intrauterine adhesion (synechiae).
Objective: To evaluate and compare the rate and severity of synechiae formation after myomectomy by laparotomy and laparoscopy.
Materials and Methods: In this non-randomized interventional trial, hysteroscopy was performed in all married fertile women who had undergone myomectomy (type 3-6 interamural and subserosal fibroids) via laparotomy and laparoscopy in Tehran’s Arash Hospital from 2010 to 2013. Three months after the operation, the occurrence rate and severity of intrauterine synechiae, and its relationship with type, number and location of myomas were investigated and compared in both groups.
Results: Forty patients (19 laparoscopy and 21 laparotomy cases) were studied. Both groups were similar regarding the size, type (subserosal or intramural), number and location of myoma. The occurrence rate of synechiae in the laparoscopy and laparotomy group was 21% and 19%, respectively; showing no significant difference (p=0.99). Among all patients, no significant relationship was found between the endometrial opening (p=0.92), location (p=0.14) and type of myoma (p=0.08) with the occurrence rate of synechiae. However, a significant relationship was observed between myoma’s size (p=0.01) and the location of the largest myoma with the occurrence of synechiae (p=0.02).
Conclusion: With favorable suturing methods, the outcome of intrauterine synechiae formation after myomectomy, either performed by laparotomy or laparoscopy, is similar. In all cases of myomectomy in reproductive-aged women, postoperative hysteroscopy is highly recommended to better screen intrauterine synechiae.
Objective: To evaluate and compare the rate and severity of synechiae formation after myomectomy by laparotomy and laparoscopy.
Materials and Methods: In this non-randomized interventional trial, hysteroscopy was performed in all married fertile women who had undergone myomectomy (type 3-6 interamural and subserosal fibroids) via laparotomy and laparoscopy in Tehran’s Arash Hospital from 2010 to 2013. Three months after the operation, the occurrence rate and severity of intrauterine synechiae, and its relationship with type, number and location of myomas were investigated and compared in both groups.
Results: Forty patients (19 laparoscopy and 21 laparotomy cases) were studied. Both groups were similar regarding the size, type (subserosal or intramural), number and location of myoma. The occurrence rate of synechiae in the laparoscopy and laparotomy group was 21% and 19%, respectively; showing no significant difference (p=0.99). Among all patients, no significant relationship was found between the endometrial opening (p=0.92), location (p=0.14) and type of myoma (p=0.08) with the occurrence rate of synechiae. However, a significant relationship was observed between myoma’s size (p=0.01) and the location of the largest myoma with the occurrence of synechiae (p=0.02).
Conclusion: With favorable suturing methods, the outcome of intrauterine synechiae formation after myomectomy, either performed by laparotomy or laparoscopy, is similar. In all cases of myomectomy in reproductive-aged women, postoperative hysteroscopy is highly recommended to better screen intrauterine synechiae.
Type of Study: Original Article |
References
1. Sami Walid M, Heaton RL. The role of laparoscopic myomectomy in the management of uterine fibroids. Curr Opin Obstet Gynecol 2011; 23: 273-277. [DOI:10.1097/GCO.0b013e328348a245]
2. Cramer SF, Patel A. The frequency of uterine leiomyomas. Am J Clin Pathol 1990; 94: 435-438. [DOI:10.1093/ajcp/94.4.435]
3. Buttram VC, Rater RC. Uterine leiomyomata: etiology, symptomatology and management. Fertil Steril 1981; 36: 433-445. [DOI:10.1016/S0015-0282(16)45789-4]
4. Olive DL, Lindheim SR, Pritts EA. Non-surgical management of leiomyomata: impact on fertility. Curr Opin Obstet Gynecol 2004; 16: 239-243. [DOI:10.1097/00001703-200406000-00006]
5. Lefebvre G AA, Jeffrey J, Vilos G. The management of uterine leiomyomas. SOGC Clinical Practice Guideline No. 128. J Obstet Gynaecol Can 2003; 25: 396-405.
6. Ellis H. The clinical significance of adhesions: focus on intestinal obstruction. Eur J Surg Suppl 1997; 577: 5-9.
7. Semm K. New methods of pelviscopy (gynecologic laparoscopy) for myomectomy, ovariectomy, tubectomy and adnectomy. Endoscopy 1979; 11: 85-93. [DOI:10.1055/s-0028-1098329]
8. Mais V, Ajossa S, Guerriero S, Mascia M, Solla E, Melis GB. Laparoscopic versus abdominal myomectomy: a prospective, randomized trial to evaluate benefits in early outcome. Am J Obstet Gynecol 1996; 175: 654-658. [DOI:10.1016/S0002-9378(96)70445-3]
9. Seracchioli R, Rossi S, Govoni F, Rossi E, Venturoli S, Bulletti C, et al. Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy. Hum Reprod 2000; 15: 2663-2668. [DOI:10.1093/humrep/15.12.2663]
10. Rossetti A, Sizzi O, Soranna L, Cucinelli F, Mancuso S, Lanzone A. Long-term results of aparoscopic myomectomy: recurrence rate in comparison with abdominal myomectomy. Hum Reprod 2001; 16: 770-774. [DOI:10.1093/humrep/16.4.770]
11. Legendre G, Brun J, Fernandez H. The place of myomectomy in woman of reproductive age. J Gynecol Obstet Biol Reprod 2011; 40: 875-884. [DOI:10.1016/j.jgyn.2011.09.023]
12. Peacock K, Hurst BS. Laparoscopic Myomectomy. Surg Technol Int 2006; 15: 141-145.
13. Diamond MP, Freeman ML. Clinical implications of postsurgical adhesions. Hum Reprod 2001; 7: 567-576. [DOI:10.1093/humupd/7.6.567]
14. Cobellis L, Pecori E, Cobellis G. Comparison of intramural myomectomy scar after laparotomy or laparoscopy. Int J Gynaecol Obstet 2004; 84: 87-88. [DOI:10.1016/S0020-7292(03)00301-1]
15. Schenker JG. Etiology of and therapeutic approach to synechia uteri. Eur J Obstet Gynecol Reprod Biol 1996; 65: 109-113. [DOI:10.1016/0028-2243(95)02315-J]
16. Taskin O, Sadik S, Onoglu A, Gokdeniz R, Erturan E, Burak F, et al. Role of endometrial suppression on the frequency of intrauterine adhesions after resectoscopic surgery. Am Assoc Gynecol Laparosc 2000; 7: 351-354. [DOI:10.1016/S1074-3804(05)60478-1]
17. Valle RF, Sciarra JJ. Intrauterine adhesions: Hystreoscopic diagnosis, classification, treatment and reproductive outcome. Am J Obstet Gynecol 1988; 158: 1459-1470. [DOI:10.1016/0002-9378(88)90382-1]
18. Gambadauro P, Gudmundsson J, Torrejon R. Intrauterine Adhesions following Conservative Treatment of Uterine Fibroids. Hindawi Obstet Gynecol Int 2012; 853269: 1-6. [DOI:10.1155/2012/853269]
19. Touboul C, Fernandez H, Deffieux X, Berry R, Frydman R, Gervaise A. Uterine synechiae after bipolar hysteroscopic resection of submucosal myomas in patients with infertility. Fertil Steril 2009; 92: 1690-1693. [DOI:10.1016/j.fertnstert.2008.08.108]
20. Practice Committee of the American Society for Reproductive M. Current evaluation of amenorrhea. Fertil Steril 2006; 86: 148-155. [DOI:10.1016/j.fertnstert.2006.08.013]
21. Schenker JG, Margalioth EJ. Intrauterine adhesions: an updated appraisal. Am J Obstet Gynecol 1982; 37: 593-610.
22. Czernobilsky B. Endometritis and infertility. Fertil Steril 1978; 30: 119-130. [DOI:10.1016/S0015-0282(16)43448-5]
23. Schreinemacher MH, Richard P, Bakkum EA, van Goor H, Bouvy ND. Adhesion awareness: a national survey of surgeons. World J Surg 2010; 34: 2805-2812. [DOI:10.1007/s00268-010-0778-8]
24. Tixier H, Grevoul J, Loffroy R, Lauferon J, Guiu B, Mutamba W, et al. Preoperative embolization or ligature of the uterine arteries in preparation for conservative uterine fibroma surgery. Acta Obstet Gynecol Scand 2010; 89: 1310-1315. [DOI:10.3109/00016349.2010.512060]
25. Munro MG, Critchley HO, Broder MS, Fraser IS. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynecol Obstet 2011; 113: 3-13. [DOI:10.1016/j.ijgo.2010.11.011]
26. Al‐Inany H. Intrauterine adhesions. Acta Obstet Gynecol Scand 2001; 80: 986-993.
27. Tulandi T, al-Took S. Endoscopic myomectomy. Laparoscopy and hysteroscopy. Obstet Gynecol Clin North Am 1999; 26: 135-148. [DOI:10.1016/S0889-8545(05)70063-2]
28. Shavell VI, Saed GM, Diamond MP. Review: cellular metabolism: contribution to postoperative adhesion development. Reprod Sci 2009; 16: 627-634. [DOI:10.1177/1933719109332826]
29. Sizzi O, Rossetti A, Malzoni M, Minelli L, La Grotta F, Soranna L, et al. Italian multicenter study on complications of laparoscopic myomectomy. J Minimal Invas Gynecol 2007; 14: 453-462. [DOI:10.1016/j.jmig.2007.01.013]
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