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Güler O, Hatırnaz Ş, Sparic R, Basbug A, Erol O, Kalkan Ü, Ulubaşoğlu H, Trojano G, Ürkmez SS, Tinelli A. Long-term obstetric, perinatal, and surgical complications in singleton pregnancies following previous cesarean myomectomy: a retrospective multicentric study. Front Surg 2024; 11:1430439. [PMID: 39149134 PMCID: PMC11324572 DOI: 10.3389/fsurg.2024.1430439] [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: 05/09/2024] [Accepted: 07/16/2024] [Indexed: 08/17/2024] Open
Abstract
Objectives The safety of cesarean myomectomy has been proven by previous studies. Our study aimed to reveal the long-term perinatal, obstetric, and surgical outcomes of cesarean myomectomy (CM) by comparing different CM techniques. Material and methods This retrospective multicentric case-control study involved 7 hospitals and included 226 singleton pregnancies that underwent repeated cesarean section (CS) between 2015 and 2020. Among these pregnancies, 113 of 226 cases had CM (Group A), and 113 had only CS (Group B). Of the 113 cases in which CM was performed, 58 underwent endometrial myomectomy (EM) (Subgroup A1) and 55 underwent serosal myomectomy (SM) (Subgroup A2). The groups were compared in terms of obstetric, perinatal, and surgical outcomes, and fibroid recurrence, myomectomy scar healing rate, and adhesion formation were noted. Results There was no significant difference between the groups in terms of maternal age, body mass index, gravidity, parity, and fibroid diameter in previous CS (p > 0.05). In the perinatal and obstetric evaluation of the groups, there was no significant difference between the groups in terms of neonatal weight, Apgar score, fetal growth restriction, preterm premature rupture of membranes, preterm delivery, hypertension in pregnancy, and diabetes mellitus (p > 0.05). The fibroid recurrence rate was 28.3%, and the myomectomy scar good healing rate was 99.1%. There was no difference between the groups in terms of CS duration, preoperative and postoperative hemoglobin levels, perioperative blood transfusion rates, febrile morbidity, and prolonged hospitalization (p > 0.05). In terms of adhesion formation, although the adhesion rate of the SM group was higher than that of the EM group, no statistically significant difference was detected between the groups. Conclusion This study showed that in pregnancies following CM, obstetrical, perinatal, and surgical outcomes were unaffected. Obstetricians can safely use CM, either the trans-endometrial or serosal technique, as it is a safe and effective method with long-term results.
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Affiliation(s)
- Oğuz Güler
- Department of Obstetrics and Gynecology, Private Asya Hospital, Istanbul, Turkey
| | - Şafak Hatırnaz
- Department of Obstetrics and Gynecology, Mediliv Medical Center, Samsun, Turkey
| | - Radmila Sparic
- Clinic for Obstetrics and Gynecology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Alper Basbug
- Department of Obstetrics and Gynecology, School of Medicine, Duzce University, Duzce, Turkey
| | - Onur Erol
- Department of Obstetrics and Gynecology, Memorial Antalya Hospital, Antalya, Turkey
| | - Üzeyir Kalkan
- Department of Obstetrics and Gynecology, Koç University Hospital, Istanbul, Turkey
| | - Hasan Ulubaşoğlu
- Department of Obstetrics and Gynecology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Giuseppe Trojano
- Department of Obstetrics and Gynecology, Madonna Delle Grazie Hospital, Matera, Italy
| | - Sebati Sinan Ürkmez
- Department of Medical Biochemistry, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkiye
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology, and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Italy
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Dai QH, Zhang L, Chen AE. Prognostic and reproductive outcomes in women who had uterine myomas removed during cesarean section and sutured using different techniques. BMC Womens Health 2024; 24:7. [PMID: 38166995 PMCID: PMC10763254 DOI: 10.1186/s12905-023-02852-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND In this study, the prognostic and reproductive outcomes of women who underwent excision of uterine myomas and were sutured using different techniques while undergoing a cesarean section were investigated. METHODS A total of 299 females who underwent cesarean section between January 2015 and June 2022 due to a scarred uterus were enrolled in this study. These participants were segregated into two categories: the experimental group (comprising 155 cases) in which uterine myoma (single lesion) was excised during the cesarean procedure, and the control group (consisting of 144 cases) in which only the cesarean section was conducted. A comparison between the two groups was carried out based on the following parameters: volume of intraoperative bleeding (mL), additional measures taken for intraoperative hemostasis (n, %), percentage (%) of patients experiencing postoperative fever, duration required for the passage of gas (hours [h]), length of hospital stay (days [d]), weight of newborns (kg) and their Apgar scores, and the reproductive outcomes of the experimental group assessed two years after the surgical procedure. RESULTS In the experimental group, the amount of bleeding during surgery, occurrence of postoperative fever among women, time taken for patients to resume passing gas, and length of hospital stay were 540.65 ± 269.12 mL, 9.03%, 15.99 ± 4.68 h, and 5.08 ± 1.18 days, respectively. In contrast, the control group had values of 409.03 ± 93.24 mL, 2.77%, 16.24 ± 4.92, and 4.47 ± 0.70 days, respectively (P < 0.05). No notable increase was observed in the need for additional intraoperative hemostasis measures, and there was no significant difference in the time it took for patients to pass gas after the surgery. All newborns had positive health status. In the experimental group, 25 patients underwent subsequent pregnancies, and 15 of them successfully reached full-term deliveries, all of which had positive outcomes. CONCLUSION Combining myomectomy with various suture methods during cesarean delivery did not cause excessive bleeding and resulted in healthy newborns. This approach offers the advantage of avoiding additional surgeries under anesthesia and can be considered a viable option. Subsequent pregnancies after myomectomy were considered high-risk.
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Affiliation(s)
- Qiao-Hong Dai
- Department of Gynecology and Obstetrics, Ningbo Women and Children's Hospital, 339 Liuting Street, Haishu District, Ningbo, Zhejiang, 315000, China
| | - Lu Zhang
- Department of Internal Medicine, Ningbo Urology & Nephrology Hospital, Ningbo, 315000, China
| | - An-Er Chen
- Department of Gynecology and Obstetrics, Ningbo Women and Children's Hospital, 339 Liuting Street, Haishu District, Ningbo, Zhejiang, 315000, China.
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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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Matasariu DR, Ursache A, Himiniuc L, Toma B, Boiculese VL, Grigore M, Dumitrascu I. Research on myoma in Northeastern Romania and socio-medical outcomes. Exp Ther Med 2022; 23:30. [PMID: 34824638 PMCID: PMC8611495 DOI: 10.3892/etm.2021.10952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/07/2021] [Indexed: 11/13/2022] Open
Abstract
Myomas are the most common benign uterine tumors in women of childbearing age, with an incidence of up to 77% and a major impact on women's health. The aim of our study was to provide information concerning the incidence and prevalence of myomas in the patients admitted to a tertiary referral center in Northeastern Romania. This retrospective study conducted at the Iasi 'Cuza Voda' University Hospital of Obstetrics and Gynecology (Romania) included 11,538 patients, representing all patients admitted to the gynecology department between January 2013 and December 2019. During the study interval, the number of hysterectomies (total and for myomas) had increased. The rate of laparoscopic surgery showed a small decrease (31.3% from 34%), classic therapy showed a decrease by more than 10% and the hysteroscopy rate was tripled. There are few studies in the literature that have established with accuracy the incidence of myomas. In the present study, the prevalence of hysterectomy for myomas was 54.42%. Our results are in agreement with the data in the literature, namely that 40-60% of all performed hysterectomies are for myomas. The vast majority of admissions for myomas involve a surgical procedure most commonly hysterectomy.
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Affiliation(s)
- Daniela Roxana Matasariu
- Department of Obstetrics and Gynecology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Alexandra Ursache
- Department of Obstetrics and Gynecology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Loredana Himiniuc
- Department of Obstetrics and Gynecology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Bogdan Toma
- Department of Obstetrics and Gynecology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Vasile Lucian Boiculese
- Department of Preventive Medicine and Interdisciplinarity Medical Informatics and Biostatistics, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Mihaela Grigore
- Department of Obstetrics and Gynecology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Obstetrics and Gynecology, ‘Cuza Voda’ Obstetrics and Gynecology Clinical Hospital, 700038 Iasi, Romania
| | - Irina Dumitrascu
- Department of Obstetrics and Gynecology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Obstetrics and Gynecology, ‘Cuza Voda’ Obstetrics and Gynecology Clinical Hospital, 700038 Iasi, Romania
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Yıldırım Karaca S, Kantarcı S, Adıyeke M, Bulut S, Özcan A, Rabia Şenkaya A, İleri A. Comparison of transendometrial myomectomy versus conventional myomectomy in cesarean section. Eur J Obstet Gynecol Reprod Biol 2021; 267:68-72. [PMID: 34731639 DOI: 10.1016/j.ejogrb.2021.10.019] [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: 09/19/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the surgical results of transendometrial myomectomy (TEM) and conventional myomectomy (CM) procedures for fibroid in cesarean section. MATERIAL AND METHODS This retrospective study was conducted with computer-based medical records of patients who underwent myomectomy during cesarean section between January 2013 and March 2019. During the study period, 41 patients underwent transendometrial myomectomy, and 52 patients with had conventional myomectomy. In all patients included in the study, myoma was single, intramural, and localized in the anterior of the uterus. RESULTS The total duration of surgery was shorter in the TEM group than in the CM group (50,5 ± 10 min vs 63,6 ± 15,2, p = 0,001). There was no difference in terms of length of hospital stay, procedure-related hemoglobin difference, blood transfusion requirement and postoperative fever (respectively, p = 0,65, p = 0,81, p = 0,33 and p = 0,9). Patients who underwent TEM (0.58 ± 0.61) had significantly lower adhesion scores in their subsequent pregnancy compared to patients who underwent CM (1,76 ± 1,1) (p = 0,001). CONCLUSION Transendometrial myomectomy technique seems to be more advantageous in selected patients compared to the conventional technique due to the shorter operation time.
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Affiliation(s)
- Suna Yıldırım Karaca
- Izmir Tepecik Education and Reseach Hospital, Department of Obstetrics and Gynecology, Izmir, Turkey.
| | - Sercan Kantarcı
- Izmir Tepecik Education and Reseach Hospital, Department of Obstetrics and Gynecology, Izmir, Turkey
| | - Mehmet Adıyeke
- Izmir Tepecik Education and Reseach Hospital, Department of Obstetrics and Gynecology, Izmir, Turkey
| | - Sertaç Bulut
- Izmir Tepecik Education and Reseach Hospital, Department of Obstetrics and Gynecology, Izmir, Turkey
| | - Aykut Özcan
- Izmir Katip Celebi University, School of Medicine, Department of Obstetrics and Gynecology, Izmir, Turkey
| | - Ayşe Rabia Şenkaya
- Izmir Tepecik Education and Reseach Hospital, Department of Obstetrics and Gynecology, Izmir, Turkey
| | - Alper İleri
- Izmir Tepecik Education and Reseach Hospital, Department of Obstetrics and Gynecology, Izmir, Turkey
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HORTU İ, ALGÜL F, DURMAZ B, AKDEMİR A, ŞAHİN Ç, ERGENOĞLU AM, AKERCAN F. Sezaryen sırasında miyomektomi: Perioperatif sonuçların değerlendirilmesi. EGE TIP DERGISI 2020. [DOI: 10.19161/etd.834155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Large Uterine Fibroids in Pregnancy with Successful Caesarean Myomectomy. Case Rep Obstet Gynecol 2020; 2020:8880296. [PMID: 33224543 PMCID: PMC7671803 DOI: 10.1155/2020/8880296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/15/2020] [Accepted: 10/28/2020] [Indexed: 11/18/2022] Open
Abstract
Uterine fibroid is the commonest benign tumour of the female reproductive tract. It occurs in 20–40% of women, whereas the estimated incidence in pregnancy is 0.1–3.9%. Uterine fibroid in pregnancy is usually asymptomatic with complications occurring in 10–30% of cases. The first line of management is conservative with counselling for myomectomy after delivery. However, in the presence of intractable symptoms, both antepartum myomectomy and caesarean myomectomy have been reported to be successfully performed in carefully selected cases. We report a case of large subserous uterine fibroid in pregnancy that was referred to our centre at 14 weeks of gestation. She developed generalized body weakness, backache, and breathlessness at 27 weeks gestation. Thus, she was admitted and managed conservatively for eight weeks with significant relief of symptoms. She eventually had a caesarean myomectomy at 35 weeks of gestation; the outcome was a live female baby with a birth weight of 2.3 kg and a large subserous fibroid weighing 9.5 kg. We can therefore say that caesarean myomectomy can be safely performed in carefully selected cases.
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Goyal M, Dawood AS, Elbohoty SB, Abbas AM, Singh P, Melana N, Singh S. Cesarean myomectomy in the last ten years; A true shift from contraindication to indication: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 256:145-157. [PMID: 33232889 DOI: 10.1016/j.ejogrb.2020.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/17/2020] [Accepted: 11/05/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND A lot of debate is present about Cesarean myomectomy (CM) in women with uterine myoma whether to consider it a feasible and safe procedure or an absolute contraindication. OBJECTIVE To assess the safety and feasibility of myomectomy during cesarean section in women with uterine myoma. SEARCH STRATEGY Electronic search was made on MEDLINE, EMBASE, Cochrane Library, ISI web of knowledge and Scopus from January 1, 2008 to December 31, 2019 using terms "Caesarean section", "Myomectomy", "Fibroid", "Caesarean myomectomy". SELECTION CRITERIA All full length studies either prospective or retrospective that address caesarean myomectomy were included. DATA COLLECTION AND ANALYSIS The outcomes studied were haemorrhage, mean change in haemoglobin, operative time, need for blood transfusion, febrile morbidity and duration of hospital stay. RESULTS Total 249 studies were assessed for eligibility and 17 studies included in analysis with 6545 women. There were 4702 (71.85 %) women in caesarean myomectomy (CM) group and 1843 (28.15 %) women in cesarean section (CS) group. There was statistically significant but clinically insignificant decrease in hemoglobin [MD = 0.27, 95 %CI = 0.08-0.45, p = 0.005; very low quality], significant higher need for blood transfusion [RR = 1.45, 95 %CI = 1.05-1.99, p = 0.02; high quality] in CM group versus CS alone. The mean operative time (minutes) [MD = 14.77, 95 %CI = 6.91-22.64, p = 0.0002; moderate quality] and mean hospital stay (days) [MD = 0.36, 95 %CI = 0.19-0.53, p < 0.00001; high quality] was significantly less in CM group, though of not any clinical significance. No difference in incidence of haemorrhage [RR = 1.16, 95 %CI = 0.86-1.56, p = 0.32; moderate quality evidence] and fever [RR = 1.17, 95 %CI = 0.83-1.65), p = 0.36; moderate quality] in two groups. CONCLUSIONS The meta-analysis suggests CM is associated with clinical insignificant increase in operative time, blood loss and hospital stay, especially with multiple and large size myomas. CM should be preferred over CS alone especially by experienced surgeons with appropriate haemostatic techniques and tertiary care centres.
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Affiliation(s)
- Manu Goyal
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, Jodhpur, India.
| | - Ayman Shehata Dawood
- Assistant professor of Obstetrics and Gynecology, Tanta University, Tanta, Egypt
| | - Shereen B Elbohoty
- Assistant professor of Obstetrics and Gynecology, Tanta University, Tanta, Egypt
| | - Ahmed M Abbas
- Assistant Professor of Obstetrics and Gynecology, Assuit University, Assuit, Egypt
| | - Pratibha Singh
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, Jodhpur, India
| | - Nitesh Melana
- Consultant Paediatrician, SN Medical College, Jodhpur, India.
| | - Surjit Singh
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, 342005, India
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9
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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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Hatırnaz Ş, Güler O, Başbuğ A, Çetinkaya MB, Kanat-Pektaş M, Bakay K, Çelik S, Şentürk Ş, Soyer-Çalışkan C, Gürçağlar A, Şahin B, Kalkan Ü, Çelik H, Kalyoncu Ş, Bıyık İ, Yassa M, Erol O, Akarsu S, Turhan U, Ulubaşoğlu H, Sparic R, Tinelli A. A Comparative Multicentric Study on Serosal and Endometrial Myomectomy During Cesarean Section: Surgical Outcomes. J INVEST SURG 2020; 34:687-694. [DOI: 10.1080/08941939.2020.1725188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Şafak Hatırnaz
- Medicana Samsun International Hospital, IVF Center, Sansun, Turkey
| | - Oğuz Güler
- Department of Obstetrics and Gynecology, Bilge Hastanesi, Istanbul, Turkey
| | - Alper Başbuğ
- Department of Obstetrics and Gynecology, School of Medicine, Duzce University, Duzce, Turkey
| | - Mehmet Bilge Çetinkaya
- Department of Obstetrics and Gynecology, School of Medicine, Ondokuzmayis University, Samsun, Turkey
| | - Mine Kanat-Pektaş
- Department of Obstetrics and Gynecology, School of Medicine, Kocatepe University, Afyon, Turkey
| | - Kadir Bakay
- Department of Obstetrics and Gynecology, School of Medicine, Ondokuzmayis University, Samsun, Turkey
| | - Samettin Çelik
- Maternity Hospital, Samsun Training and Research Hospital, Samsun, Turkey
| | - Şenol Şentürk
- Department of Obstetrics and Gynecology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | | | - Aysemin Gürçağlar
- Department of Obstetrics and Gynecology, School of Medicine, Amasya University, Amasya, Turkey
| | - Banuhan Şahin
- Department of Obstetrics and Gynecology, School of Medicine, Amasya University, Amasya, Turkey
| | - Üzeyir Kalkan
- Department of Obstetrics and Gynecology, Özel Egemed Hospital Söke, Aydın, Turkey
| | - Handan Çelik
- Department of Obstetrics and Gynecology, School of Medicine, Ondokuzmayis University, Samsun, Turkey
| | - Şenol Kalyoncu
- Department of Obstetrics and Gynecology, Private Office, Ankara, Turkey
| | - İsmail Bıyık
- Department of Obstetrics and Gynecology, Kütahya Sağlık Bilimleri Üniversitesi, Kütahya, Turkey
| | - Murat Yassa
- Department of Obstetrics and Gynecology, Sağlık Bilimleri Üniversitesi, Şişli Etfal Hastanesi, İstanbul, Turkey
| | - Onur Erol
- Department of Obstetrics and Gynecology, Sağlık Bilimleri Üniversitesi, Antalya Eğitimve Araştırma Hastanesi, Antalya, Turkey
| | | | - Uğur Turhan
- Maternity Hospital, Samsun Training and Research Hospital, Samsun, Turkey
| | - Hasan Ulubaşoğlu
- Maternity Hospital, Samsun Training and Research Hospital, Samsun, Turkey
| | - Radmila Sparic
- Clinic of Gynecology and Obstetrics, Clinical Center of Serbia, Višegradska, Serbia
- School of Medicine, University of Belgrade, Serbia
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology, Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Lecce, Italy
- Laboratory of Human Physiology, PhystechBioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russia
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Liu D, Han M, Huang P, Li C, Li X. Use of the base purse-string suture approach to remove giant uterine fibroids during cesarean section. J Int Med Res 2019; 48:300060519893868. [PMID: 31889467 PMCID: PMC7783271 DOI: 10.1177/0300060519893868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective This study aimed to investigate the optimal strategy for myomectomy for
removing giant uterine fibroids when necessary in women undergoing cesarean
section. Methods This study was retrospective in design, and assessed outcomes in 26 patients
who underwent myomectomy using a “base purse-string suture” during cesarean
section. The operative duration, blood loss, uterine involution, and
duration of postpartum lochia were analyzed. Results This suture was associated with a mean operative duration of 11.17 ± 5.36
minutes and the mean estimated blood loss was 11.15 ± 6.05 mL. The mean
postpartum duration of lochia was 34.92 ± 7.55 days and there were no cases
of postpartum hemorrhage. Uterine size returned to normal within 6 weeks of
delivery, without any apparent defects or abnormalities in the uterine wall
as shown by an ultrasonic examination. Conclusion This novel implementation of a base purse-string suture during cesarean
myomectomy for removal of giant fibroids is a simple, safe, and effective
intervention that should be considered for implementation in appropriate
patients.
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Affiliation(s)
- Dan Liu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Min Han
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Pu Huang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chunfang Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xuelan Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Sparić R, Papoutsis D, Bukumirić Z, Kadija S, Spremović Radjenović S, Malvasi A, Lacković M, Tinelli A. The incidence of and risk factors for complications when removing a single uterine fibroid during cesarean section: a retrospective study with use of two comparison groups. J Matern Fetal Neonatal Med 2019; 33:3258-3265. [PMID: 30700185 DOI: 10.1080/14767058.2019.1570124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To determine the incidence of and risk factors for perioperative complications in women with a single uterine fibroid, who had a cesarean myomectomy (CM).Methods: This was a retrospective study of women who had a CM between 2015-2016. They were compared versus women who had a cesarean section (CS) alone and nonpregnant women who had a laparotomic myomectomy (LM).Results: We identified 44 CM women, 51 CS patients, and 44 LM women. Those with a CM in most cases had subserosal at the anterior uterine wall and near the lower uterine segment (LUS), as most frequent fibroids; moreover, they had, on average, 18 min longer surgery duration versus CS alone. CM did not affect the Apgar scores and the incidence of minor and major complications was 36.4% and 29.5%, with the most frequent being postoperative anemia (36.4%) and intraoperative hemorrhage (29.5%). No significant differences were reported on both minor and major complications in the three groups. The following variables were found to be significant predictors in univariate logistic regression analysis for the occurrence of major complications in women who had a CM: the fibroid size (OR = 1.040, 95%CI: 1.014-1.066, p = .002), and duration of surgery (OR = 1.059, 5%CI:1.012-1.108, p = .013). The fibroid diameter cut-off was 75.0 mm (sensitivity 69.2%; specificity 90.3%), and the surgery duration was 87.5 min (sensitivity 53.8%; specificity 93.5%).Conclusion: CM appears safe, with no additional risks when compared to CS alone and LM in the women of reproductive age.
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Affiliation(s)
- Radmila Sparić
- Clinic of Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dimitrios Papoutsis
- Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospital NHS Trust, Princess Royal Hospital, Apley Castle, Grainger Drive, Telford, United Kingdom
| | - Zoran Bukumirić
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Institute for Medical Statistics and Informatics, Belgrade, Serbia
| | - Saša Kadija
- Clinic of Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Svetlana Spremović Radjenović
- Clinic of Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Antonio Malvasi
- Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Moscow State University, Inststitutskii per 9, Dolgoprudny, Moscow region, Russia.,Department of Obstetric and Gynecology Santa Maria Hospital G.V.M. Care & Research, Bari, Italy
| | - Milan Lacković
- Clinic of Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia
| | - Andrea Tinelli
- Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Moscow State University, Inststitutskii per 9, Dolgoprudny, Moscow region, Russia.,Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Department of Obstetrics and Gynecology Vito Fazzi Hospital, Piazzetta Muratore, Lecce, Italy
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13
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Submucous Fibroids, Fertility, and Possible Correlation to Pseudocapsule Thickness in Reproductive Surgery. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2804830. [PMID: 30250847 PMCID: PMC6140098 DOI: 10.1155/2018/2804830] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 06/24/2018] [Indexed: 11/18/2022]
Abstract
Background and Objectives Fibroids are related to infertility. Fibroid pseudocapsule is a neurovascular bundle surrounding leiomyomas rich of neurofibers involved in myometrial biology. Authors evaluated, by a case-control study, the fibroid pseudocapsule (FP) thickness by ultrasound (US) and the histological measurements, according to uterine location of fibroids. Methods 137 consecutive patients undergoing hysterectomy for uterine myomas were enrolled and 200 myomas were evaluated. Before surgery, patients underwent an ultrasound (US) investigation to evaluate the number, the size, and the location of fibroids. After surgery, myoma-pseudocapsule-myometrium specimens were measured and evaluated by a single expert pathologist. Both US and histological data were collected and statistically analyzed. Results Our results confirm the relevant difference of FP thickness, particularly represented under the endometrium for submucous LMs. FPs near the endometrial cavity were considerably thicker than those of both intramural fibroids and subserous fibroids measured by US (P=0.0001) and histology (P=0.0001). A clear cut-off measurement at 2 mm (P=0.0001) was found between endometrial FPs and all other FPs for either US or histology measurements. Conclusion The thickness of FP is considerably higher near the endometrial cavity when compared to those of both intramural and subserous LMs, suggesting a potential role either in fertility or in myometrial healing.
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14
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Chauhan AR. Cesarean Myomectomy: Necessity or Opportunity? J Obstet Gynaecol India 2018; 68:432-436. [PMID: 30416267 DOI: 10.1007/s13224-018-1114-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/15/2018] [Indexed: 10/17/2022] Open
Abstract
Fibroids in pregnancy are increasingly common, due to advanced maternal age, better diagnostic tools and use of assisted reproductive techniques. Cesarean section (CS) is the commonest mode of delivery in these patients. Cesarean myomectomy (CM) is the term used to describe the removal of fibroids at CS; it has always been a controversial topic, with two schools of thought. Some obstetricians advise against it due to the traditional fear of massive obstetric hemorrhage and its attendant complications. However, recent literature advocates elective or opportunistic myomectomy in well-selected cases during CS. This is especially valuable in low-resource settings where the patient may be spared a repeat surgery and problems of anesthesia and cost associated with it. This review examines the recent published data on CM, its indications, technique, safety and applicability in modern obstetrics.
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Affiliation(s)
- Anahita R Chauhan
- Department of Obstetrics and Gynecology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra India
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15
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Tinelli A, Malvasi A, Favilli A, Gerli S, Stark M. What are the real advantages of trans endometrial myomectomy during cesarean delivery? J Matern Fetal Neonatal Med 2018; 32:3133-3134. [PMID: 29562791 DOI: 10.1080/14767058.2018.1456524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Andrea Tinelli
- a Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Department of Obstetrics and Gynecology , Vito Fazzi Hospital , Lecce , Italy.,b Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics , Moscow Institute of Physics and Technology (State University) , Dolgoprudny , Moscow Region , Russia
| | - Antonio Malvasi
- b Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics , Moscow Institute of Physics and Technology (State University) , Dolgoprudny , Moscow Region , Russia.,c Department of Obstetric and Gynecology , Santa Maria Hospital, GVM Care and Research , Bari , Italy
| | - Alessandro Favilli
- d Department of Obstetrics and Gynecology , University of Perugia , Perugia , Italy
| | - Sandro Gerli
- d Department of Obstetrics and Gynecology , University of Perugia , Perugia , Italy
| | - Michael Stark
- e New European Surgical Academy (NESA) , Berlin , Germany
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16
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Abstract
OBJECTIVE To assess the association of myomectomy during cesarean delivery with intraoperative and perioperative maternal morbidity. DATA SOURCES We searched MEDLINE (1966-2017), Scopus (2004-2017), ClinicalTrials.gov (2008-2017), EMBASE (1980-2017), and Cochrane Central Register of Controlled Trials CENTRAL (1999-2017) databases. METHODS OF STUDY SELECTION We selected all observational studies that reported outcomes on patients undergoing myomectomy at the time of cesarean delivery. Statistical meta-analysis was performed with RevMan 5.3. RESULTS Nineteen studies were included in our systematic review with a total number of 3,900 women. Among them, 2,301 women had myomectomy during cesarean delivery and 1,599 had cesarean delivery only. Women undergoing concomitant myomectomy had a mild decline in hemoglobin compared with those who had cesarean delivery only (mean difference 0.25 mg/dL, 95% CI 0.06-0.45). Myomectomy at the time of cesarean delivery is associated with longer surgical time compared with cesarean delivery alone (mean difference 13.87 minutes, 95% CI 4.78-22.95). Blood transfusion (odds ratio [OR] 1.41, 95% CI 0.96-2.07) and postoperative fever (OR 1.12, 95% CI 0.80-1.56) rates did not differ between the two groups (myomectomy compared with no myomectomy). A statistically, but not clinically, significant increase in postoperative hospitalization was evident in the myomectomy group (mean difference 0.35 days, 95% CI 0.25-0.46). CONCLUSION This systematic review and meta-analysis of observational studies demonstrated an association with increased operative time and hemoglobin drop in patients who underwent cesarean myomectomy compared with cesarean delivery alone. No increased rate of major hemorrhage or need for transfusion was identified. Cesarean myomectomy may be considered in cases of isolated myomas, although randomized trials are needed.
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17
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Senturk MB, Polat M, Doğan O, Pulatoğlu Ç, Yardımcı OD, Karakuş R, Tayyar AT. Outcome of Cesarean Myomectomy: Is it a Safe Procedure? Geburtshilfe Frauenheilkd 2017; 77:1200-1206. [PMID: 29200476 PMCID: PMC5703655 DOI: 10.1055/s-0043-120918] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/09/2017] [Accepted: 10/09/2017] [Indexed: 11/05/2022] Open
Abstract
Objective
Myomectomy performed during cesarean section is still controversial because of the potential for associated complications, especially with large myomas. Many obstetricians avoid performing cesarean myomectomy procedures because of the risk of uncontrollable hemorrhage. However, the prevalence of pregnant women with myomas is increasing, leading to an increase in the likelihood that physicians will encounter this issue. The aim of this study was to compare outcomes and complications of patients who either had or did not have cesarean myomectomy.
Method
A total of 361 patients were evaluated in this retrospective study. Patients who had cesarean section with myomectomy and patients had cesarean section without myomectomy were compared with regard to demographics, drop in hemoglobin levels, complications, blood transfusion rates and duration of operation. These parameters were also compared when the diameter of the myoma was larger than 5 cm. Values of p < 0.01 and p < 0.05 were considered statistically significant.
Results
While maternal age and gravidity were similar in both groups (p > 0.05), the mean myoma diameter was smaller and the duration of operation was longer in the group who underwent cesarean myomectomy (p < 0.05). The reduction in hemoglobin level, rate of complications, and number of transfusions were similar in both groups (p > 0.05).
Conclusion
This study shows that myomectomy during cesarean section does not increase complications or transfusion rates and appears to be a safe procedure.
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Affiliation(s)
- Mehmet Baki Senturk
- Department of Obstetrics and Gynecology, Medeniyet University School of Medicine, Istanbul, Turkey
| | - Mesut Polat
- Department of Obstetrics and Gynecology, Medeniyet University School of Medicine, Istanbul, Turkey
| | - Ozan Doğan
- Department of Obstetrics and Gynecology, Medeniyet University School of Medicine, Istanbul, Turkey
| | - Çiğdem Pulatoğlu
- Department of Obstetrics and Gynecology, Bayburt Government Hospital, Bayburt, Turkey
| | - Oğuz Devrim Yardımcı
- Department of Obstetrics and Gynecology, Medeniyet University School of Medicine, Istanbul, Turkey
| | - Resul Karakuş
- Departments of Obstetrics and Gynecology, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey
| | - Ahter Tanay Tayyar
- Departments of Obstetrics and Gynecology, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey
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18
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Huang SY, Shaw SW, Su SY, Li WF, Peng HH, Cheng PJ. The impact of a novel transendometrial approach for caesarean myomectomy on obstetric outcomes of subsequent pregnancy: a longitudinal panel study. BJOG 2017. [DOI: 10.1111/1471-0528.14798] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- SY Huang
- Department of Obstetrics and Gynaecology; Chang Gung Memorial Hospital-Linkou Medical Centre; Chang Gung University College of Medicine; Taoyuan Taiwan
| | - SW Shaw
- Department of Obstetrics and Gynaecology; Chang Gung Memorial Hospital-Linkou Medical Centre; Chang Gung University College of Medicine; Taoyuan Taiwan
| | - SY Su
- Department of Obstetrics and Gynaecology; Chang Gung Memorial Hospital-Linkou Medical Centre; Chang Gung University College of Medicine; Taoyuan Taiwan
| | - WF Li
- Department of Obstetrics and Gynaecology; Chang Gung Memorial Hospital-Linkou Medical Centre; Chang Gung University College of Medicine; Taoyuan Taiwan
| | - HH Peng
- Department of Obstetrics and Gynaecology; Chang Gung Memorial Hospital-Linkou Medical Centre; Chang Gung University College of Medicine; Taoyuan Taiwan
| | - PJ Cheng
- Department of Obstetrics and Gynaecology; Chang Gung Memorial Hospital-Linkou Medical Centre; Chang Gung University College of Medicine; Taoyuan Taiwan
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19
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Hatırnaz Ş, Güler O, Başaranoğlu S, Tokgöz C, Kılıç GS. Endometrial myomectomy: a novel surgical method during cesarean section. J Matern Fetal Neonatal Med 2017; 31:433-438. [DOI: 10.1080/14767058.2017.1286320] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Şafak Hatırnaz
- Department of Obstetrics and Gynecology, Private Bilge Hospital, Istanbul, Turkey
| | - Oğuz Güler
- Department of Obstetrics and Gynecology, Private Bilge Hospital, Istanbul, Turkey
| | - Serdar Başaranoğlu
- Department of Obstetrics and Gynecology, Private Bilge Hospital, Istanbul, Turkey
| | - Cengiz Tokgöz
- Department of Obstetrics and Gynecology, Private Bilge Hospital, Istanbul, Turkey
| | - Gokhan S. Kılıç
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX, USA
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20
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Sparić R, Kadija S, Stefanović A, Spremović Radjenović S, Likić Ladjević I, Popović J, Tinelli A. Cesarean myomectomy in modern obstetrics: More light and fewer shadows. J Obstet Gynaecol Res 2017; 43:798-804. [DOI: 10.1111/jog.13294] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/05/2016] [Accepted: 12/22/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Radmila Sparić
- Clinic of Gynecology and Obstetrics; Clinical Center of Serbia; Belgrade Serbia
- School of Medicine, University of Belgrade; Belgrade Serbia
| | - Saša Kadija
- Clinic of Gynecology and Obstetrics; Clinical Center of Serbia; Belgrade Serbia
- School of Medicine, University of Belgrade; Belgrade Serbia
| | - Aleksandar Stefanović
- Clinic of Gynecology and Obstetrics; Clinical Center of Serbia; Belgrade Serbia
- School of Medicine, University of Belgrade; Belgrade Serbia
| | - Svetlana Spremović Radjenović
- Clinic of Gynecology and Obstetrics; Clinical Center of Serbia; Belgrade Serbia
- School of Medicine, University of Belgrade; Belgrade Serbia
| | - Ivana Likić Ladjević
- Clinic of Gynecology and Obstetrics; Clinical Center of Serbia; Belgrade Serbia
- School of Medicine, University of Belgrade; Belgrade Serbia
| | - Jela Popović
- Higher Education School of Professional Health Studies; Belgrade Serbia
| | - Andrea Tinelli
- International Translational Medicine and Biomodeling Research Group, Department of Applied Mathematics, Moscow Institute of Physics and Technology; Moscow State University; Dolgoprudny Moscow Russia
- Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Department of Obstetrics and Gynecology; Vito Fazzi Hospital; Piazzetta Muratore Lecce Italy
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21
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Akkurt MO, Yavuz A, Eris Yalcin S, Akkurt I, Turan OT, Yalcin Y, Sezik M. Can we consider cesarean myomectomy as a safe procedure without long-term outcome? J Matern Fetal Neonatal Med 2016; 30:1855-1860. [DOI: 10.1080/14767058.2016.1228057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Mehmet Ozgur Akkurt
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Suleyman Demirel University, Isparta, Turkey,
| | - And Yavuz
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Suleyman Demirel University, Isparta, Turkey,
| | - Serenat Eris Yalcin
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Suleyman Demirel University, Isparta, Turkey,
| | - Iltac Akkurt
- Isparta Maternity and Children’s Hospital, Department of Obstetrics and Gynecology, Isparta, Turkey, and
| | - Ozerk Turel Turan
- College of Arts and Sciences, University of Miami, Coral Gables, FL, USA
| | - Yakup Yalcin
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Suleyman Demirel University, Isparta, Turkey,
| | - Mekin Sezik
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Suleyman Demirel University, Isparta, Turkey,
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Dedes I, Schäffer L, Zimmermann R, Burkhardt T, Haslinger C. Outcome and risk factors of cesarean delivery with and without cesarean myomectomy in women with uterine myomatas. Arch Gynecol Obstet 2016; 295:27-32. [DOI: 10.1007/s00404-016-4177-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
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23
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Sparić R, Malvasi A, Kadija S, Babović I, Nejković L, Tinelli A. Cesarean myomectomy trends and controversies: an appraisal. J Matern Fetal Neonatal Med 2016; 30:1114-1123. [PMID: 27328626 DOI: 10.1080/14767058.2016.1205024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Although the first report on cesarean myomectomy (CM) was a century ago, the management of a myomectomy during a cesarean section (CS) remains controversial. The objective of this study is to provide the latest data on this topic regarding the techniques and complications of CM. METHODS The authors consulted the most important scientific databases investigating the indications and contraindications for CM, the operational techniques, benefits and complications. RESULTS CM provides the benefits of two surgeries in one laparotomy, avoiding the risks of repeated anesthesia and relaparotomy. Nevertheless, in some patients, CM may be associated with increased morbidity and, in such cases, an interval myomectomy might be a safer option. Myomas compromising fetal extraction and uterine incision and/or suturing should be preferably enucleated during CS. CM is generally considered relatively safe in cases of anterior wall myomas, subserous and pedunculated myomas, particularly if a myomectomy is feasible without additional hysterotomy. Multiple myomas, deep intramural, fundal and cornual myomas and posterior uterine wall myomas are associated with more surgical complications during CM. CONCLUSIONS With increasing reports in favor of CM, the risk-benefit ratio should be still evaluated with randomized controlled trials, in order to achieve more data on CM.
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Affiliation(s)
- Radmila Sparić
- a Clinic of Gynecology and Obstetrics, Clinical Center of Serbia , Belgrade , Serbia.,b School of Medicine, University of Belgrade , Belgrade , Serbia
| | - Antonio Malvasi
- c International Translational Medicine and Biomodeling Research Group, Department of Applied Mathematics Moscow Institute of Physics and Technology, Moscow State University, Russia.,d Department of Obstetrics & Gynecology , Santa Maria Hospital, GVM Care & Research , Bari , Italy
| | - Saša Kadija
- a Clinic of Gynecology and Obstetrics, Clinical Center of Serbia , Belgrade , Serbia.,b School of Medicine, University of Belgrade , Belgrade , Serbia
| | - Ivana Babović
- a Clinic of Gynecology and Obstetrics, Clinical Center of Serbia , Belgrade , Serbia.,b School of Medicine, University of Belgrade , Belgrade , Serbia
| | - Lazar Nejković
- e Clinic of Gynecology and Obstetrics "Narodni Front" , Belgrade , Serbia , and
| | - Andrea Tinelli
- c International Translational Medicine and Biomodeling Research Group, Department of Applied Mathematics Moscow Institute of Physics and Technology, Moscow State University, Russia.,f Division of Experimental Endoscopic Surgery , Imaging, Technology and Minimally Invasive Therapy, Department of Obstetrics and Gynecology Vito Fazzi Hospital , Lecce , Italy
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Topçu HO, İskender CT, Timur H, Kaymak O, Memur T, Danışman N. Outcomes after cesarean myomectomy versus cesarean alone among pregnant women with uterine leiomyomas. Int J Gynaecol Obstet 2015; 130:244-6. [DOI: 10.1016/j.ijgo.2015.03.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 03/10/2015] [Accepted: 05/05/2015] [Indexed: 10/23/2022]
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25
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Palla VV, Karaolanis G, Ioannis K, Anastasiou I, Hassiakos D. Pros and Cons of Cesarean Myomectomy: A Retrospective Study. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2014.0047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Viktoria-Varvara Palla
- Second Department of Obstetrics and Gynecology, Medical School, University of Athens, Aretaieion Hospital, Athens, Greece
| | - Georgios Karaolanis
- Second Department of General Surgery, Medical School, University of Athens, Laiko Hospital, Athens, Greece
| | - Katafigiotis Ioannis
- First University Urology Clinic, Laiko Hospital, University of Athens, Athens, Greece
| | - Ioannis Anastasiou
- First University Urology Clinic, Laiko Hospital, University of Athens, Athens, Greece
| | - Demetrios Hassiakos
- Second Department of Obstetrics and Gynecology, Medical School, University of Athens, Aretaieion Hospital, Athens, Greece
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The safety of cesarean myomectomy in women with large myomas. Obstet Gynecol Sci 2014; 57:367-72. [PMID: 25264526 PMCID: PMC4175596 DOI: 10.5468/ogs.2014.57.5.367] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Revised: 03/25/2014] [Accepted: 04/28/2014] [Indexed: 11/08/2022] Open
Abstract
Objective To evaluate the safety of cesarean myomectomy in large myomas sized >5 cm. Methods One hundred sixty-five pregnant women with myomas who delivered via cesarean section were identified. Ninety-six women had cesarean section without myomectomy, and 65 women underwent cesarean myomectomy. We compared the maternal characteristics, neonatal weight, myoma types, and operative outcomes between two groups. We further analyzed cesarean myomectomy group according to myoma size. The large myoma was defined as myoma >5 cm in size. The maternal characteristics, neonatal weight, and myoma types were compared between two groups. We also compared the operative outcomes such as preoperative and postoperative hemoglobin, operative time, and hospitalized days between two groups. Results There were no significant differences in the maternal characteristics, myoma types, neonatal weight and operative outcomes between cesarean section without myomectomy and cesarean myomectomy. The subgroup analysis according to myoma size (>5 cm or not) in cesarean myomectomy group revealed that there were no significant differences in the mean hemoglobin change (1.2 vs. 1.3 mg/dL, P=0.6), operative time (90.5 vs. 93.1 minutes, P=0.46), and the length of hospital stay (4.7 vs. 5.2 days, P=0.15) between two groups. The comparison of maternal characteristics, neonatal weight, and myoma types between two groups also showed no statistical significance. Conclusion Cesarean myomectomy in patients with large myomas is a safe and effective procedure.
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Tinelli A, Mynbaev OA, Mettler L, Hurst BS, Pellegrino M, Nicolardi G, Kosmas I, Malvasi A. A combined ultrasound and histologic approach for analysis of uterine fibroid pseudocapsule thickness. Reprod Sci 2014; 21:1177-86. [PMID: 24879045 DOI: 10.1177/1933719114537719] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Authors investigated 75 patients with uterine myomas, appraising whether fibroid pseudocapsule (FP) thickness varies depending on fibroid location, by a prospective cohort trial (level of evidence II-2) settled in University-affiliated Hospitals. Uteri were scanned via bidimensional and power Doppler ultrasound (US) to map the fibroids and record the FP thickness, prior to hysterectomy for symptomatic uterine fibroids. After hysterectomy, FP specimens were sampled and analyzed by pathologists. Ultrasound and histology data were matched. Pseudocapsule thickness of 108 fibroids was measured: subserosal fibroids (SSFs), intramural fibroids (IMFs), and fibroids near the endometrial cavity (FEC). The FEC's pseudocapsules were considerably thicker than those of IMF and SSF measured by US and histology (P = .001). A clear cutoff existed between FEC pseudocapsule thickness and all other pseudocapsules, with significant differences observed at 2 mm (P = .001). Similarity between histological and US measurements was observed only with IMF pseudocapsules, whereas FEC or SSF showed significant differences. The pseudocapsule of fibroids is considerably thicker near the endometrial cavity when compared to those of both IMFs and SSFs. Since fibroids closest to the endometrial cavity are the most involved in fertility and infertility and FP is considerably thicker near the endometrial cavity, it is possible to hypothesize an involvement of FP of fibroid near the endometrium since FP contains many neuropeptides and neurotransmitters that are physiologically active, even if these data may take on a broader meaning in a study on a larger number of patients.
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Affiliation(s)
- Andrea Tinelli
- Department of Obstetrics and Gynecology, Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Lecce, Italy
| | - Ospan A Mynbaev
- Moscow Institute of Physics & Technology, State University, Moscow, Russia Laboratory of pilot projects Moscow State University of Medicine & Dentistry, Moscow, Russia Department of ObGyn and Reproductive Medicine, Peoples' Friendship University of Russia, Moscow, Russia
| | - Liselotte Mettler
- Department of Obstetrics and Gynaecology, Kiel School of Gynaecological Endoscopy, University, Hospitals Schleswig-Holstein, Campus Kiel, Germany
| | - Brad S Hurst
- Assisted Reproduction Center, Carolinas Medical Center, Charlotte, NC, USA
| | | | - Giuseppe Nicolardi
- Human Anatomy and Neuroscience Unit, University of Salento, Lecce, Italy
| | - Ioannis Kosmas
- Department of Obstetrics and Gynecology, University of Ioannina, Ioannina, Greece
| | - Antonio Malvasi
- Department of Obstetric & Gynecology, Santa Maria Hospital, Bari, Italy
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