Comparison of Intra and Post-Operative Outcomes between Laparoscopic and open Myomectomy for Uterine Fibroids
DOI:
https://doi.org/10.48047/Keywords:
: Fibroid, myomectomy, laparoscopic myomectomy, benign tumor of uterus, uterine myoma, open myomectomy.Abstract
Background
Myomas or fibroids are commonly encountered in clinical practice and are present in more than 50% of the reproductive aged women. According to the Global Burden of Disease (2019) data, the global incident cases of uterine myomas has increased. The choice of treatment for reproductive aged women with symptoms needing to preserve their fertility is still myomectomy. There are two main approaches of performing myomectomy i.e., abdominal/open and laparoscopic. There have been recent evidence indicating that laparoscopic myomectomy is associated with shorter recovery time, lower risk of post-operative complications and overall similar clinical outcomes when compared to open myomectomy
Objective
To compare the intra-operative and post-operative clinical outcomes among women undergoing open and laparoscopic myomectomy
Methods This is a retrospective study done in a tertiary care hospital in Odisha, India. Data from women who undergone either of the two surgical approaches between February 2016 to December 2018 were utilized. The outcomes of interest were estimated blood loss, duration of surgery, need for blood transfusion, duration of hospitalization, indicators of recovery and post-operative complications. Regression analysis was done to document the association of surgery type with the outcomes. Effect sizes were reported either as mean difference (MD) or odds ratio (OR) with 95% confidence intervals (CI).
Results
A total of 140 subjects were included in this study (laparoscopic group (LM)=60 and open myomectomy group (OM)=80). Those undergoing LM had lower blood loss (in ml) (MD -21.0; 95% CI: -37.5 to -4.47) and a higher surgical time (in min) (MD 13.0; 95% CI : 3.0 to 23.1), compared to OM. The duration of hospitalization (in days) was comparatively lower in those undergoing LM (MD -2.42; 95% CI: -2.47 to -2.37). The women undergoing LM had higher odds of being free from analgesic at 2nd post-operative day (OR 5.90 ; 95% CI :2.82 to 12.3) and discharged by 3rd to 5th post-operative day (OR 4.74 ; 95% CI :2.27 to 9.91). The risk of need for blood transfusion and post-operative complications were similar in both the groups.
Conclusions
The findings suggest that laparoscopic myomectomy offers clear advantage in terms of improved clinical outcomes when compared to conventional open myomectomy.
