Morbidity, fertility and pregnancy outcomes after myoma enucleation by laparoscopy versus laparotomy
Myomas are defined as benign tumours that arise from smooth muscle cells of the uterus. Clinically, they are found in 5–77% of women of reproductive age. The prevalence rate varies considerably in the literature and a large number of fibroids do not cause symptoms. The lifetime risk of acquiring myomas is 70% for Caucasian women and ≥ 80% for African American women.
The data of 265 patients undergoing surgery for symptomatic myomas by laparoscopy or laparotomy, performed in the gynaecological department of Hannover Medical School, Hannover, Germany, between 2009 and 2013, were retrospectively analysed in this retrospective design study.
High pregnancy rates (up to 70%) and birth rates (up to 86%) after myomectomy, regardless of the surgical approach adopted, were found in the current study. The trend was that ≥ 3 myomas and those that were ≥ 6 cm in size were almost always removed by laparotomy in our clinic. It was possible to remove up to 42 myomas without having to perform a hysterectomy. A statistically significant negative correlation was observed in relation to the association between the size of the largest myoma extracted and the pregnancy rate (p = 0.02). A statistically significant correlation between the number of removed myomas and the pregnancy rate was observed for patients who wished to bear children (p = 0.010). Elevated complication rates (of up to 50%) were reported for more than three extracted myomas with a statistically significance (p = 0.0471).
It is necessary to ensure sound preoperative selection of the surgical approach in order to achieve the most optimal results, especially for those patients who wished to bear children.
KeywordsMyoma Myomectomy Pregnancy rate Birth rate Laparoscopy Laparotomy Surgical approach Morbidity
SK: Project development, manuscript writing, data management. CI: Data collection. IS: Protocol development. GG-R: Project development. HH: Data management. PS: Manuscript editing. PH: Protocol development. CS: Project development, manuscript editing, data management.
There was no funding.
Compliance with ethical standards
Conflict of interest
We declare that we have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of Hanover Medical School on 16th of February 2015 (No: 2593-2015).
- 1.Drinville SJ, Memarzadeh S (2007) Benign disorders of the uterine corpus. Curr Diagn Treat Obstet Gynecol 10:639–653Google Scholar
- 2.Lethaby A, Vollenhoven B (2002) Fibroids. Clin Evid 14:1666–1678Google Scholar
- 6.Floss K, Garcia-Rocha GJ, Kundu S, von Kaisenberg CS, Hillemanns P, Schippert C (2015) Fertility and pregnancy outcome after myoma enucleation by minilaparotomy under microsurgical conditions in pronounced uterus myomatosus. Geburtshilfe Frauenheilkd 75(1):56–63CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Practice Committee of American Society for Reproductive Medicine in collaboration with Society of Reproductive Surgeons (2008) Myomas and reproductive function. Fertil Steril 90(5 Suppl.):125–130Google Scholar
- 18.Griffiths A, D’Angelo A, Amso N (2006) Surgical treatment of fibroids for subfertility. Cochrane Database Syst Rev 3:CD003857Google Scholar