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Sparić R, Andrić L, Guler O, Malvasi A, Babović I, Hatirnaz S, Dellino M, Tinelli A. Cesarean Myomectomy: Reflections on Clinical and Surgical Controversies between a New Trans-Decidual Technique vs. Traditional Method. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:609. [PMID: 38674255 PMCID: PMC11052397 DOI: 10.3390/medicina60040609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/04/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024]
Abstract
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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Affiliation(s)
- Radmila Sparić
- Faculty of Medicine, University of Belgrade, Dr Subotića 8, 11000 Belgrade, Serbia;
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, Dr Koste Todorovića 26, 11000 Belgrade, Serbia;
| | - Luka Andrić
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, Dr Koste Todorovića 26, 11000 Belgrade, Serbia;
| | - Oguz Guler
- Department of Obstetrics and Gynecology, Private Asya Hospital, Yenimahalle mh. 537, St. No.5 Gaziosmanpasa, 34250 Istanbul, Turkey;
| | - Antonio Malvasi
- Department of Interdisciplinary Medicine (DIM), University of Bari, Aldo Moro, 70100 Bari, Italy; (A.M.); (M.D.)
| | - Ivana Babović
- Faculty of Medicine, University of Belgrade, Dr Subotića 8, 11000 Belgrade, Serbia;
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, Dr Koste Todorovića 26, 11000 Belgrade, Serbia;
| | - Safak Hatirnaz
- Mediliv Medical Center, Kale, Mevlevihane Cd. No.11, 55100 Samsun, Turkey;
| | - Miriam Dellino
- Department of Interdisciplinary Medicine (DIM), University of Bari, Aldo Moro, 70100 Bari, Italy; (A.M.); (M.D.)
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology, CERICSAL (CEntro di RIcerca Clinico SALentino), “Veris delli Ponti Hospital”, Via Giuseppina Delli Ponti, 73020 Scorrano, Italy;
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Wang Q, Lin J, Dai Y. Outcomes of cesarean myomectomy via trans-endometrial approach in women with single intramural fibroid in the posterior uterine wall. J Matern Fetal Neonatal Med 2023; 36:2232655. [PMID: 37433647 DOI: 10.1080/14767058.2023.2232655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/12/2023] [Accepted: 06/29/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE To evaluate the feasibility and effectiveness of cesarean myomectomy (CM) via trans-endometrial approach in pregnant women with single intramural fibroid in the posterior uterine wall. METHODS Ninety-eight patients with single intramural fibroids in the posterior uterine wall who underwent CM were divided into two groups depending on surgical style. The study group consisted of 50 patients who underwent trans-endometrial myomectomy (EM), whereas the control group included 48 patients who had trans-serosal myomectomy (SM). Patients' demographic data, intraoperative and postoperative outcomes were analyzed retrospectively. RESULTS No significant differences were found in the baseline characteristics of the two groups, including demographic data, size, location of fibroids, comorbidities, and indications for cesarean section. During the perioperative period, we did not observe significant differences between the two groups in terms of intraoperative hemorrhage, blood transfusion rate, postoperative fever incidence and postoperative hospitalization (all p > .05). It's worth noting that the time of operation and postoperative ventilation in the EM group was shorter than that in the SM group (p < .05). More importantly, estimated blood loss and postoperative hemoglobin decline were less in the EM group than in the SM group (p < .05). CONCLUSION EM seems to be a viable approach to CM for the treatment of single intramural fibroids in the posterior wall, with the potential advantages of short operative time, low intraoperative bleeding, and low risk of pelvic adhesions.
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Affiliation(s)
- Qi Wang
- Fujian Key Laboratory of Women and Children's Critical Diseases Research, Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, P.R. China
| | - Jinxiao Lin
- Fujian Key Laboratory of Women and Children's Critical Diseases Research, Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, P.R. China
| | - Yan Dai
- Fujian Key Laboratory of Women and Children's Critical Diseases Research, Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, P.R. China
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Shi C, Chen J, Chen A. Clinical outcome analysis of intramural myoma greater than 8 cm in diameter removed during caesarean section: a retrospective study. BMC Womens Health 2023; 23:60. [PMID: 36774454 PMCID: PMC9921307 DOI: 10.1186/s12905-023-02210-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 02/03/2023] [Indexed: 02/13/2023] Open
Abstract
OBJECTIVE To explore the safety and efficiency of endometrial myomectomy (EM) and Serosal myomectomy (SM) for the removal of intramural myoma greater than 8 cm in diameter during cesarean section. METHODS Retrospective analysis and follow-up were used, and 190 cases of pregnancy complicated with uterine myoma from Jan. 2017 to May 2022 in Ningbo Women's and Children's Hospital were collected, 130 cases of caesarean myomectomy as study group, 64 cases of EM as study group A, 66 cases of SM as study group B, 33 cases with uterine fibroids removed before suturing the uterine incision as study group B1, 33 cases with uterine incision sutured followed by removal of fibroids as study group B2, 60 cases of Caesarean section alone as control group. To compare perioperative conditions between and within groups. RESULTS ① Operation time, postoperative exhaust time, pre- and post-operative haemoglobin drop, intraoperative blood loss were all more than those of the control group in the study group (68.65 ± 11.87 vs 56.17 ± 9.18 min, 21.04 ± 4.98 vs 17.03 ± 1.3 h, 1.27 ± 0.59 vs 1.09 ± 0.43 g/dl, 613 ± 221 vs 532 ± 156 ml, P < 0.001, P < 0.001, P = 0.025, P = 0.011). ② For type III and V fibroids, the time of myoma removal, postoperative exhaust and pre- and post-operative haemoglobin drop and intraoperative blood loss in study group A were less than those in study group B (18.02 ± 3.89 vs 20.19 ± 5.32 min, 18.83 ± 2.57 vs 23.93 ± 6.84 h, 600 ± 194 vs 730 ± 277 ml, 1.20 ± 0.57 vs 1.59 ± 0.70 g/dl, P = 0.036, P < 0.001, P = 0.014, P = 0.008); For type IV uterine fibroids, only postoperative exhaust time was less in Study Group A than in Study Group B (19.27 ± 2.2 vs 21.35 ± 3.23 h, P = 0.016). ③ Time of myoma removed was less in study group B1 than in study group B2 (18.24 ± 4.53 vs 20.7 ± 4.59 min, P = 0.033). CONCLUSION It is safe and feasible to remove interstitial myomas larger than 8 cm in diameter during caesarean section. EM has the advantage of shorter operation time and less intraoperative bleeding, SM, in a way that the myoma is removed before suturing the uterine incision, can shorten the myomectomy time. It can benefit the patients more.
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Affiliation(s)
- Chunbo Shi
- Department of Obstetrics and Gynecology, Ningbo Women and Children’s Hospital, Ningbo, 315012 Zhejiang China
| | - Jinliang Chen
- Radiology Department, Ningbo Women and Children’s Hospital, Ningbo, 315012 Zhejiang China
| | - Aner Chen
- Department of Obstetrics and Gynecology, Ningbo Women and Children's Hospital, Ningbo, 315012, Zhejiang, China.
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Dai Y, Xia L, Lin J, Xu R, You W. Study on the method of enucleation of anterior uterine fibroids by transverse incision of the lower uterine segment during cesarean section. BMC Pregnancy Childbirth 2021; 21:744. [PMID: 34732155 PMCID: PMC8564958 DOI: 10.1186/s12884-021-04226-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/22/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction A retrospective study was conducted to investigate the effectiveness and feasibility of fibroid enucleation in the anterior wall of the uterus by transverse uterine incision during cesarean section. Methods The medical history, surgical data, preoperative and postoperative changes in the blood system, and complications of 90 pregnant women who underwent myomectomy of the anterior uterine wall during cesarean section at the second Department of Maternal and Child Health Hospital of Fujian Province were analyzed retrospectively. Results No significant differences were noted in the leiomyoma number, pathological type, preoperative and postoperative hemoglobin level, perioperative bleeding incidence, blood transfusion frequency, postoperative fever incidence, and duration of lochia between the study and control groups. The proportion of large fibroids was slightly higher in the study group than in the control group (p < 0.05), and the operation time and average hospitalization time were slightly longer in the study group than in the control group (p < 0.05). The distribution of type III–V fibroids was slightly more in the study group than in the control group (p < 0.05), and the distribution of type VI fibroids in the study group was less than that in the control group (p < 0.05). Conclusion Fibroid enucleation is safe and effective in the anterior wall of the uterus through the lower uterine transverse incision in cesarean section. It has the potential to reduce the risk of pelvic and intrauterine adhesions in the future.
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Affiliation(s)
- Yan Dai
- Department of obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, FuZhou, 350001, FuJian, China.
| | - Li Xia
- Department of obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, FuZhou, 350001, FuJian, China.
| | - Jinxiao Lin
- Department of obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, FuZhou, 350001, FuJian, China
| | - Rongli Xu
- Department of obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, FuZhou, 350001, FuJian, China
| | - Wenqiang You
- Department of obstetrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, FuZhou, 350001, FuJian, China
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Huang Y, Ming X, Li Z. Feasibility and safety of performing cesarean myomectomy: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2020; 35:2619-2627. [PMID: 32674632 DOI: 10.1080/14767058.2020.1791816] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To examine the feasibility and safety of performing cesarean myomectomy on pregnant women with myomas compared to cesarean section only. METHODS We retrieved English articles in the PubMed, Cochrane Library, Medline and EMBASE databases from inception to April 2020. Observational studies including the comparison of patients who underwent cesarean myomectomy and cesarean section, as well as those reporting perioperative outcomes were selected. Data extraction was conducted using RevMan 5.3. RESULTS Twenty-three studies comprising 8,016 women were included in the meta-analysis. Of these, 3,955 underwent cesarean myomectomy, while 4,061 underwent cesarean section only. Cesarean myomectomies were associated with a greater decline in mean hemoglobin (mean difference [MD] 0.20 g/dL, 95% confidence intervals [CI] 0.06, 0.35, p = .007), greater incidence of hemorrhage (odds ratio [OR] 1.46, 95% CI 1.06, 2.01, p = .02), greater volume of blood loss (MD 45.54 ml, 95% CI 2.68, 88.41, p = .04), higher transfusion rate (OR 1.47 95%CI 1.09, 1.99, p = .01), longer operation duration (MD 10.40 min, 95% CI 8.54, 12.25, p < .001), or longer postoperative hospitalization (MD 0.18 d, 95% CI 0.12, 0.24, p < .001), compared to those who underwent cesarean section only. There was no statistical difference in postoperative fever rates (OR 1.12, 95% CI 0.77, 1.62). CONCLUSION Hemorrhage represents a risk factor which should not be overlooked by surgeons performing cesarean myomectomy. Intramural myomas, myomas ≥7 cm in size, and multiple myomas are associated with more intraoperative hemorrhage and prolonged operation duration. We suggest that, with appropriate hemostatic techniques and when performed by experienced surgeons, cesarean myomectomy may be safe and feasible in selected patients with myomas, regardless of size and locations, except if they are located at the cornual or close to large vessels, and in the absence of uterine atony during surgery.
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Affiliation(s)
- Yue Huang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People's Republic of China
| | - Xiu Ming
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People's Republic of China
| | - Zhengyu Li
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, People's Republic of China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People's Republic of China
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