Single layer suturing in intracapsular myomectomy of intramural myomas is sufficient for a normal wound healing

Prapas, Yannis; Zikopoulos, Athanasios; Petousis, Stamatios; Xiromeritis, Panayotis; Tinelli, Andrea; Ravanos, Konstantinos; Margioula‐Siarkou, Chrysoula; Chalkia-Prapa, Eleni-Markella; Prapas, Nikos

doi:10.1016/j.ejogrb.2020.03.042

Cited by 9 publications

(9 citation statements)

References 23 publications

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“…Some researchers suggest that a multilayer closure is necessary to achieve the same degree of wound integrity as in abdominal myomectomy. However, similar to our study in recent years, as reported by Paul et al and Prapas et al, there are studies reporting that the risk of successful live pregnancy and uterine rupture is not different with single‐layer suture 11,12 …”

Section: Discussionsupporting

confidence: 92%

“…No uterine rupture was reported during pregnancy. 12 Because there is no clear evidence of myometrial tissue closure, the currently recommended practice is to close the uterus according to a laparotomic approach, which is a prudent approach. Some researchers suggest that a multilayer closure is necessary to achieve the same degree of wound integrity as in abdominal myomectomy.…”

Section: Discussionmentioning

confidence: 99%

“…However, similar to our study in recent years, as reported by Paul et al and Prapas et al, there are studies reporting that the risk of successful live pregnancy and uterine rupture is not different with single-layer suture. 11,12 For uterine reconstruction, excessive suturing may cause a foreign body reaction and tissue ischemia that prevents proper muscle healing and reproductive function. Adequate repair has been reported to depend not on the number of suture layers, but on the placement of a full-thickness, evenly placed suture and the prevention of hematoma formation.…”

Section: Discussionmentioning

confidence: 99%

“…1 Vicryl were included and 121 of whom were pregnant, Prapas et al performed LM in patients with myoma‐type FIGO type 3‐6 with a diameter range of 4‐14 cm. No uterine rupture was reported during pregnancy 12 …”

Section: Discussionmentioning

confidence: 99%

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Pregnancy outcomes of patients undergoing single‐layer sutured laparoscopic myomectomy

et al. 2021

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Uterine myomas are common benign tumours caused by smooth muscle cells of the uterus. 1 The treatment of myomas includes medical, surgical and radiological interventions. Each treatment has its pros and cons. Treatment choice is affected by the patient's child expectation, accompanying diseases, myoma localisation and previous treatment modality. 2,3 Abdominal, vaginal, laparoscopic and robotic methods are used in surgical treatment. Because of the short recovery time, less blood loss and less postoperative pain, a shift from laparotomy to minimally invasive surgery is observed over the years. 4 Laparoscopic myomectomy (LM) is a minimally invasive surgery.However, there is a lack of data on good evidence of long-term fertility and pregnancy outcomes. One of the most important concerns about laparoscopic myomectomy is the theoretically increased risk of uterine rupture during pregnancy. Even though uterine rupture is a rare obstetric incident, its consequences can be lifethreatening for both the mother and fetus. Although there are no studies supporting multilayer closure against single-layer closure of the myometrium during LM, the overall tendency is in favour of multilayer suturing. Because there are no prospective randomised studies comparing single and double closure, there is no clear evidence and consensus in the literature on this subject. 5,6 In this study, we aimed to investigate the pregnancy outcomes of 102 patients who underwent LM and those who underwent singlelayer suturing.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pregnancy outcomes of patients undergoing single‐layer sutured laparoscopic myomectomy

et al. 2021

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“…The quality of healing of the myometrial incision after myomectomy can be evaluated by ultrasound [6] [7].…”

Section: Introductionmentioning

confidence: 99%

Faster Healing Process by Sparing Intramural Myoma’s Pseudocapsule during Laparoscopic Myomectomy Compared with Removing It during Open Myomectomy

Zikopoulos¹,

Prapas²,

Paraskevaidi³

et al. 2021

IJCM

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Uterine fibroids are the most common benign tumours in the reproductive system. They are proliferations of smooth muscle cells of the myometrium containing a large quantity of extracellular matrix and they are surrounded by a pseudo capsule of compressed areolar tissue and smooth muscle cells. They can cause various symptoms such as menorrhage, pain and infertility and therefore they can be a traumatic experience for several women. The treatment of choice is myomectomy. In the past, myomectomy was performed by relatively atraumatic techniques, which involved stretching the myoma from its pseudocapsule to extract the fibroid directly from the surrounding fibromuscular tissue, breaking up the fibrous bridge. Modern laparoscopic intracapsular myomectomy (LIM), however, leaves the fibrovascular network surrounding the myoma (namely the "fibroid neurovascular bundle") intact which reduces the bleeding and/or uterine musculature trauma, and spares the neuropeptide fibers of the pseudocapsule.

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Impact of FIGO type 3 uterine fibroids on in vitro fertilization outcomes: A systematic review and meta‐analysis

Favilli

Etrusco

Chiàntera

et al. 2023

Intl J Gynecology & Obste

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BackgroundThe effect of FIGO (the International Federation of Gynecology & Obstetrics) type 3 myomas on in vitro fertilization (IVF) is uncertain.ObjectivesTo evaluate whether FIGO type 3 myomas affect IVF outcomes, through a systematic review and meta‐analysis (CRD42022379700).Search strategyElectronic databases were searched until November 15, 2022.Selection criteriaStudies evaluating the effects of FIGO type 3 myomas on IVF outcome.Data collection and analysisPooled results were expressed as odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity was assessed using Higgins I2. Sources of heterogeneity were explored with sensitivity and subgroup analyses.Main resultsIn total, 1020 patients were included: 324 with FIGO type 3 myomas and 696 controls (without myomas). A pooled data analysis showed a significantly lower live birth rate (OR 2.16, 95% CI 1.55–3.01, I2 = 0%, P < 0.00001), clinical pregnancy rate (OR 2.06, 95% CI 1.52–2.81, I2 = 0%, P < 0.00001), and implantation rate (OR 1.77, 95% CI 1.35–2.32, I2 = 0%, P < 0.00001) in women with untreated myomas compared with controls. The number and size of fibroids correlated with a worsening of IVF outcomes.ConclusionsFIGO type 3 myomas are significantly associated with a lower implantation rate, cumulative pregnancy rate, and live birth rate. Furthermore, their deleterious effect on the outcome of IVF increases further with increasing size and number. Nevertheless, no firm conclusions could be drawn about the potential benefits of surgery for FIGO type 3 uterine fibroids on IVF outcomes.

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Single layer suturing in intracapsular myomectomy of intramural myomas is sufficient for a normal wound healing

Cited by 9 publications

References 23 publications

Pregnancy outcomes of patients undergoing single‐layer sutured laparoscopic myomectomy

Pregnancy outcomes of patients undergoing single‐layer sutured laparoscopic myomectomy

Faster Healing Process by Sparing Intramural Myoma’s Pseudocapsule during Laparoscopic Myomectomy Compared with Removing It during Open Myomectomy

Impact of FIGO type 3 uterine fibroids on in vitro fertilization outcomes: A systematic review and meta‐analysis

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