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  • Recurrence of Uterine Leiomyomas, Adhesions and Dehiscence post Myomectomy at Time of Cesarean Section
  • Bakkalár
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    Introduction: Uterine leiomyomas are the most common tumor in patients with a uterus of reproductive age. They present a major public health problem due to their high frequency, incidence, morbidity and affect on fertility. Currently, leiomyoma recurrence rate is of debate and pelvic adhesions post myomectomy, their surgical removal, are defective. The aim of this retrospective cohort study was to better understand and describe recurrence of uterine fibroids, formation of pelvic adhesions and uterine dehiscence in patients that had an abdominal (AM) versus laparoscopic (LM) or robotic-assisted laparoscopic myomectomy (RALM) at a time of subsequent cesarean section (CS).
    Methods: This was a retrospective chart review at Brigham and Women’s Hospital and Partners Hospitals with a history myomectomy cases from January 1st 2009 through December 31st 2016 and a subsequent CS. Recurrence of leiomyoma, pelvic adhesions and uterine dehiscence noted in CS operation reports were recorded.
    Results: Results: A total of 352 cases were initially included. Of the 352 cases identified, 47 met the exclusion criteria. The 305 remaining cases included 290 cesarean sections and 16 vaginal deliveries. There were 48 (63.2%) and 68 (29.7%) patients with pelvic adhesions in the AM and LM/RALM (p-value <0.001), respectively, demonstrating statistically less adhesiogenesis in the LM/RALM group. Uterine dehiscence was observed in 21 (6.9%) of 305 cases with five (6.6%) and 16 (7.0%) cases in the AM and LM/RALM groups, respectively. (p=0.868). Estimated blood loss (EBL) differed by type as mean EBL was 957.3(432.4)mL in the AM group and 790.5(332.7)mL in the LM/RALM group (p=0.001) Recurrence of fibroids occurred in 105 (33,43%) of the 305 patients included in the study, thereof were 33 (43.4%) and 72 (31.4%) patients in the AM and LM/RALM group (p=0.07), respectively. If the number of previously removed leiomyomas were not accounted for, the study found LM/RALM to have a lower OR=0.611 of recurrence, compared to AM (p=0.0716). Accounting for the myoma number changed the OR=1.989 (p=0.0801), pointing to the number of leiomyomas removed in prior myomectomy to make a significant difference. The change in OR for each leiomyoma removed, OR=1.13. Regression analysis of the data demonstrated that compared to AM, recurrence of leiomyomas was positively associated with LM/RALM (OR 2.325, 95% CI 1.042-5.19), in a statistically significant fashion. Furthermore, pelvic adhesions were found to be negatively associated with LM/RALM (OR 0.289, 95% CI 0.12-0.72).
    Conclusion: The study found that at time of a subsequent cesarean section, patients with a history of laparoscopic or robotic-assisted laparoscopic myomectomy was positively associated with a recurrence of uterine leiomyomas (OR 2.325, 95% CI 1.042-5.19) when adjusted for confounding variables, and negatively associated with pelvic adhesions (OR 0.289, 95% CI 0.12-0.72)., compared to abdominal myomectomy.

  • Menntasjóður Læknadeildar
  • 22.9.2020

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