Intrauterine adhesions after open myomectomy: an audit

Conforti, Alessandro; Krishnamurthy, Geeta B.; Dragamestianos, Christos; Kouvelas, S; Fava, Alison Micallef; Tsimpanakos, Ioannis; Magos, Adam

doi:10.1016/j.ejogrb.2014.04.034

Cited by 18 publications

(24 citation statements)

References 21 publications

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“…Few data are available concerning intrauterine synechiae after abdominal myomectomy are rare and those exist are heterogeneous, yet globally they conclude on the interest of preserving uterine cavity integrity in case of infertile patients . Asgari et al did not find differences in intrauterine adherence rates 3 months after a myomectomy performed either by laparotomy or laparoscopy .…”

Section: Discussionmentioning

confidence: 99%

“…Intrauterine adhesion rates of 37% have been reported after resection of solitary myomas, while rates of 45% have been reported after resection of multiple myomas . Myomectomy through laparotomy and laparoscopy can also induce intrauterine adhesion, with rates ranging from 9% to 50% in certain studies after laparotomy . This high incidence could potentially have an impact on the fertility of operated women and could justify a hysteroscopic control for early lysis of velamentous adhesions after surgical intervention .…”

Section: Introductionmentioning

confidence: 99%

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Fertility and obstetrical outcomes after robot‐assisted laparoscopic myomectomy

Huberlant

Lenot

Neron

et al. 2019

Robotics Computer Surgery

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Objective: To evaluate fertility after robot-assisted laparoscopic myomectomy (RALM) in terms of pregnancy rates, and obstetrical outcomes.Patients: This is a retrospective cohort of RALM performed for symptomatic leiomyomas among women who want to conceive. Medical data were retrospectively reviewed. An office hysteroscopy was prescribed 3 months after the surgery.Results: Fifty-three patients were included. The mean number of myomas was 2 ± 1.5 with a mean size of 69 ± 17.7 mm. A breach of the cavity was noticed in 15.1% of the cases. Two cases of intrauterine adhesions were diagnosed and treated during the post-operative office hysteroscopy (5.7%).Clinical pregnancy rates were 52.8% with a live birth rate of 41.5% in patients desiring pregnancy. A caesarean section was performed in 17 cases (70.8%). No case of uterine rupture was reported.Conclusion: More than half of the patients became pregnant after RALM. A low rate of obstetrical complications was reported, with no uterine ruptures, highlighting the promise of this technique for infertile patients.infertility, miscarriage, myoma, robot-assisted myomectomy, synechiae imaging, strict and appropriate patient selection, and appropriate training in the safe practices of contained morcellation. 36 Although the number of subjects is higher than in some other studies, the present study is limited by its observational and retrospective nature. A randomized study, comparing standard laparoscopy vs robot-assisted myomectomy, would clarify the benefits of robot assistance on pregnancy rates, obstetrical complications, and intrauterine adherences more accurately (Table 7). | CONCLUSIONIn this retrospective series, we report 52.8% pregnancy rates after robot-assisted myomectomy in patients desiring pregnancy, and 47% pregnancy rates in infertile patients (half undergoing ART). In all, 78% of pregnancies gave way to a live birth, the majority through programmed caesarean sections. A low rate of obstetrical complications was reported, with no uterine ruptures, and no abnormal placentation. After systematic post-operative hysteroscopy in patients desiring pregnancy, a 5.7% intrauterine adhesion rate was found, a lower rate than those after laparoscopy or laparotomy published in the literature. This low synechiae rate probably contributes to fertility preservation.These results are encouraging for improving fertility after robotassisted myomectomy. A comparative, prospective, multicentre study, comparing standard laparoscopy vs robot-assisted laparoscopy in patients operated for myomectomy, with a longer follow-up, is highly encouraged.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fertility and obstetrical outcomes after robot‐assisted laparoscopic myomectomy

Huberlant

Lenot

Neron

et al. 2019

Robotics Computer Surgery

View full text Add to dashboard Cite

show abstract

“…The rare and neglected complication of myomectomy is the development of intrauterine adhesions. 5 This case highlights the importance of meticulous closure of endometrium during myomectomy to avoid complications in future.…”

Section: Introductionmentioning

confidence: 82%

“…However, none of them had severe adhesions, which was in contrast to our case, the most strange thing is that these all women were asymptomatic. 5 The adhesions lead to retrograde menstruation. Menstrual blood contains viable cells, which are transported into the peritoneal cavity and may implant onto the surface of exposed tissues, predominantly the peritoneum.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Endometriosis and Intrauterine Adhesions after Myomectomy

Yousuf¹

2016

Journal of South Asian Federation of Obstetrics and Gynaecology

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Aims:To report a case of iatrogenic endometrioses as a result of improper closure of endometrial cavity during myomectomy. Case report:A 30-year-old para 1 has been self-referred to our institution for medical care. A fibroid protruding the endometrial canal was removed 8 months prior to this hospital admission. In less than a month after initial myomectomy, she began experiencing severe pelvic pain more accentuated during menstruation. The pain became progressively worse. The magnetic resonance imaging results are suggestive of ovarian endometrioma. She underwent total abdominal hysterectomy and bilateral salpingo-oophrectomy. Cut surface of uterine cavity shows obliteration of endometrial canal with hourglass constriction. Conclusion:Closure of endometrium during myomectomy should be carefully done; keeping an account on patency of endometrial canal is essential to prevent iatrogenic endometriosis.

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“…E-mail: gambadauro@gmail.com; pietro.gambadauro@ki.se DOI: 10.3109/01443615.2014.987116 years, irrespective of factors such as cavity opening or specimen weight (Conforti et al 2014).…”

mentioning

confidence: 99%

Why is age a major determinant of reproductive outcomes after myomectomy in subfertile women?

Gambadauro

2014

Journal of Obstetrics and Gynaecology

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Intrauterine adhesions after open myomectomy: an audit

Cited by 18 publications

References 21 publications

Fertility and obstetrical outcomes after robot‐assisted laparoscopic myomectomy

Fertility and obstetrical outcomes after robot‐assisted laparoscopic myomectomy

Iatrogenic Endometriosis and Intrauterine Adhesions after Myomectomy

Why is age a major determinant of reproductive outcomes after myomectomy in subfertile women?

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