Outcomes of cesarean myomectomy via trans-endometrial approach in women with single intramural fibroid in the posterior uterine wall

Wang, Qi; Lin, Jinxiao; Dai, Yan

doi:10.1080/14767058.2023.2232655

Cited by 3 publications

(6 citation statements)

References 26 publications

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“…As the authors of the new method state, EM seems like a reasonable option for myomas close to the LUS incision site, which cannot be excised through LUS incision [15]. Conversely, EM could be the recommended technique to remove fibroids during CS if the pregnant woman has pelvic adhesions, which make it difficult to remove the uterus from the abdominal wall, for obvious reasons [17]. EM has no stated contraindications, but it should not be offered in women with a history of multiple trans-endometrial surgeries, a history of Asherman syndrome, placental adhesion abnormalities, and possibly in cases with a history of thin endometrium.…”

Section: Trans-endometrial Cesarean Myomectomy In Common Clinical Pra...mentioning

confidence: 99%

“…Wang et al [17] settled a retrospective cohort study including patients with intramural fibroids of the posterior uterine wall larger than 30 mm. Fifty patients with EM were included in the study group, while 48 patients with SM were in the control group.…”

Section: Investigations On Endometrial Cesarean Myomectomymentioning

confidence: 99%

“…Hatirnaz et al [14] underlined that the benefit of EM is an even smaller incision in the uterus compared to SM, which becomes even smaller with time, due to physiological uterine contractions which continue until the full involution of the uterus. Moreover, Wang et al [17] underlined that EM is more suitable for larger fibroids as the remaining muscle layer surrounding those becomes thinner, which makes easier the protrusion of fibroids into the uterine cavity, facilitating fibroid enucleation through endometrial incision. On the other hand, they proposed that trans-endometrial resection and the removal of smaller fibroids through squeezing into the uterine cavity are linked to nearly the same depth of myometrial incision as for SM.…”

Section: The Future Of Trans-endometrial Myomectomy In Modern Obstetr...mentioning

confidence: 99%

“…Hemorrhage after CM is sometimes intractable and requires cesarean hysterectomy to stop it [32]. Decreased hemorrhage during EM can be scientifically documented by lower blood loss, transfusion rates, and hemoglobin concentrations [9,10,[14][15][16][17]. Bearing in mind that CM is considered to be a challenging procedure, primarily due to the risk of uncontrollable hemorrhage, the idea of trans-endometrial approach as a way to reduce this risk sounds very promising.…”

Section: The Future Of Trans-endometrial Myomectomy In Modern Obstetr...mentioning

confidence: 99%

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Cesarean Myomectomy: Reflections on Clinical and Surgical Controversies between a New Trans-Decidual Technique vs. Traditional Method

Sparić,

Andrić,

Guler

et al. 2024

Medicina

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Up to 70–80% of women of reproductive age may be affected with the most common uterine tumors, known as fibroids or myomas. These benign tumors are the second most prevalent cause of surgery among premenopausal women. Predictions show that the occurrence of myomas in pregnancy will increase, and that the risk of having myomas during pregnancy increases with advanced maternal age. Although most women with fibroids do not experience any symptoms during pregnancy, up to 30% of women experience problems during pregnancy, childbirth, and the puerperium. The viability of myoma excision during cesarean surgery (CS) is a contentious issue raised by the rising incidence of myomas in pregnancy and CS rates. A new surgical procedure for removing fibroids using a trans-endometrial approach, which involves making an incision through the decidua itself, has put into doubt the long-standing practice of cesarean myomectomy (CM) with a trans-serosal approach. Some authors have recently advocated for this last approach, highlighting its advantages and potential uses in real-world situations. The purpose of this paper is to critique the present approach to cesarean myomectomy by analyzing the clinical and surgical distinctions between the two approaches and providing illustrations of the CM methods.

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Section: Trans-endometrial Cesarean Myomectomy In Common Clinical Pra...mentioning

confidence: 99%

Section: Investigations On Endometrial Cesarean Myomectomymentioning

confidence: 99%

Section: The Future Of Trans-endometrial Myomectomy In Modern Obstetr...mentioning

confidence: 99%

Section: The Future Of Trans-endometrial Myomectomy In Modern Obstetr...mentioning

confidence: 99%

See 2 more Smart Citations

Cesarean Myomectomy: Reflections on Clinical and Surgical Controversies between a New Trans-Decidual Technique vs. Traditional Method

Sparić,

Andrić,

Guler

et al. 2024

Medicina

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show abstract

“…These factors may lead to longer surgery duration and greater risk for postoperative complications. Literature describes techniques for endometrial myomectomy that can be performed during a caesarean section from within the uterine cavity [21].…”

Section: Introductionmentioning

confidence: 99%

Myomectomies during cesarean section and outcomes

Ruhliada

2024

Preprint

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The problem of myomectomy during cesarean section is relevant and disputable. Currently, there are no clear guidelines available for conditions and recommendations for performing this procedure during cesarean deliveries. Many obstetricians are hesitant to expand the scope of surgery due to the potential complications, such as increased intraoperative bleeding, postoperative hematomas, the risk of postoperative sepsis, venous thromboembolism, and abdominal adhesions. Additionally, long-term complications can arise from scarring on the uterus that can affect future fertility. This article presents an analysis of case series of cesarean deliveries with and without myomectomies performed at the Department of Obstetrics and Gynecology at St. Petersburg State Medical University in 2022.

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Long-term obstetric, perinatal, and surgical complications in singleton pregnancies following previous cesarean myomectomy: a retrospective multicentric study

Güler,

Hatırnaz,

Sparic

et al. 2024

Front. Surg.

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ObjectivesThe safety of cesarean myomectomy has been proven by previous studies. Our study aimed to reveal the long-term perinatal, obstetric, and surgical outcomes of cesarean myomectomy (CM) by comparing different CM techniques.Material and methodsThis retrospective multicentric case–control study involved 7 hospitals and included 226 singleton pregnancies that underwent repeated cesarean section (CS) between 2015 and 2020. Among these pregnancies, 113 of 226 cases had CM (Group A), and 113 had only CS (Group B). Of the 113 cases in which CM was performed, 58 underwent endometrial myomectomy (EM) (Subgroup A1) and 55 underwent serosal myomectomy (SM) (Subgroup A2). The groups were compared in terms of obstetric, perinatal, and surgical outcomes, and fibroid recurrence, myomectomy scar healing rate, and adhesion formation were noted.ResultsThere was no significant difference between the groups in terms of maternal age, body mass index, gravidity, parity, and fibroid diameter in previous CS (p > 0.05). In the perinatal and obstetric evaluation of the groups, there was no significant difference between the groups in terms of neonatal weight, Apgar score, fetal growth restriction, preterm premature rupture of membranes, preterm delivery, hypertension in pregnancy, and diabetes mellitus (p > 0.05). The fibroid recurrence rate was 28.3%, and the myomectomy scar good healing rate was 99.1%. There was no difference between the groups in terms of CS duration, preoperative and postoperative hemoglobin levels, perioperative blood transfusion rates, febrile morbidity, and prolonged hospitalization (p > 0.05). In terms of adhesion formation, although the adhesion rate of the SM group was higher than that of the EM group, no statistically significant difference was detected between the groups.ConclusionThis study showed that in pregnancies following CM, obstetrical, perinatal, and surgical outcomes were unaffected. Obstetricians can safely use CM, either the trans-endometrial or serosal technique, as it is a safe and effective method with long-term results.

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Outcomes of cesarean myomectomy via trans-endometrial approach in women with single intramural fibroid in the posterior uterine wall

Cited by 3 publications

References 26 publications

Cesarean Myomectomy: Reflections on Clinical and Surgical Controversies between a New Trans-Decidual Technique vs. Traditional Method

Cesarean Myomectomy: Reflections on Clinical and Surgical Controversies between a New Trans-Decidual Technique vs. Traditional Method

Myomectomies during cesarean section and outcomes

Long-term obstetric, perinatal, and surgical complications in singleton pregnancies following previous cesarean myomectomy: a retrospective multicentric study

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