Safety and Usefulness of Laparoscopic Myomectomy for Intramural Myoma in Reproductive Woman

Kim, Hyoung Choon; Oh, Sung Tack

Abstract

PURPOSE: This study was undertaken to evaluate the safety and usefulness of laparoscopic myomectomy compare to abdominal myomectomy in pregnancy outcome through estimating the uterine wall thickness in second, third trimester pregnancy and delivery.
MATERIALS AND METHODS
Total number of patients underwent operations for intramural myomectomy in Department of Obstetrics and Gynecology in Chonnam University Hospital was 95. Patients underwent laparoscopic myomectomy(Group A) patients are 42 and abdominal myomectomy (Group B) are 53 patients. Age, parity, size of fibroid, number of fibroid, indications of myomectomy, pregnancy loss, delivery methods and complications during delivery were evaluated. Uterine wall thickness in second and third trimester pregnancy was measured by Aloka SSD-2000 sonography.
RESULTS
Mean age of patients was 32.84.6 years in Group A and 32.45.1 years in Group B. Operation time, admission period and postoperative complications were not sinificantly different but operative blood loss was significantly small amount in Group A(p=0.001). Pregnancy rates was 47.6%(20/42) in Group A and 49.1%(26/53) in Group B after surgery(p=0.182). Successful delivery was 80%(16/20) in Group A and 76.9%(20/26) in Group B(p=0.182). Early pregnancy loss was 20%(4/20) in Group A and 19.2%(5/26) in Group B. Therefore pregnancy rates and successful delivery was not significantly different in Group A and B. Complications of pregnancy were premature rupture of membrane, preterm labor, pregnancy induced hypertension. There were no difference between Group A and B. In delivery methods, elective cesarean section was done 15 in Group A and 16 in Group B. Vaginal delivery was done 1 in Group A and 4 in Group B. Early pregnancy loss was 4 in Group A and 6 in Group B. Mean gestational weeks was 38.02.2 in Group A and 38.21.9 in Group B. In operative findings, adhesion was 5 in Group A and 7 in Group B at previous myomectomy site. Only one case was uterine wall thinning in Group B but maternal and fetal conditions were good. Mean uterine wall thickness was 4.2 2.5mm in Group A and 4.0 2.8mm in Group B at 2nd trimester, 4.0 2.7mm in Group A and 3.8 2.5mm in Group B at 3rd trimester, 4.0 2.5mm in Group A and 3.9 2.7mm in Group B at delivery. CONCLUSION: We conclude that pregnancy after laparoscopic myomectomy is safe, useful method comparable to abdominal myomectomy without increased risk of pregnancy loss and complications.