Removal of uterine fibroids by mini-laparotomy technique in women who wish to preserve their uterus and fertility

Uterine rupture at 28 weeks of gestation after laparoscopic myomectomy - a case report

There are many reasons for sterility, and uterine malformations are of the greatest concern. Among uterine disorders, myomas play a significant role and are present in 27% of infertile women. The occurrence of myomas is frequent - 20-40% in women of reproductive age. Thus, for those infertile patients surgical treatment may be needed to preserve an opportunity to conceive. This case report refers to an uterine rupture at 28 weeks of gestation after laparoscopic myomectomy (3 months before conceiving). The myomectomy was conducted correctly and two layers of sutures on the myometrium were performed. The purpose of the myomectomy in a young woman should be well considered. In cases of infertility, removal of the lesions is usually necessary to give the patient a chance of pregnancy. At the same time, the risk of uterine rupture is increased. There are some suggestions referring to myomectomy to reduce the risk of uterine rupture in a subsequent pregnancy. It seems that the method of sewing the uterine closure is crucial. For example, multilayer uterine stitches, preservation of the endometrial cavity, and avoidance of using electrosurgery to prevent devascularization (to avoid haematoma formation) should be taken into consideration to prevent weakness of the wall of the uterus. Uterine scars differ histologically and biochemically.

Predictors of postoperative hemoglobin drop after laparoscopic myomectomy

Introduction

Laparoscopic myomectomy (LM) can be associated with significant bleeding.

Aim

To identify factors influencing the postoperative hemoglobin (Hb) drop after LM.

Material and methods

This is a retrospective, single-center study. We evaluated data of 150 consecutive patients undergoing LM due to intramural myomas between 2010 and 2015.

Results

The median age of the patients was 37 (23–53) years. The mean diameter of the largest myoma was 5.7 ±2.3 (1.5–12) cm. The mean surgical time was 83 ±38 (35–299) min. The median number of sutures was 3 (1–11). The mean postoperative Hb drop was 1.6 ±1.2 (0–6) g/dl, and the mean estimated blood loss was 261 ±159 (50–1700) ml. In the univariate analysis, the postoperative Hb drop correlated with the duration of surgery (p < 0.001), diameter of the largest myoma (p < 0.001), cumulative myoma weight (p < 0.001), and number of sutures (p < 0.001), but not with patients’ age or number of intramural myomas. In the multivariable analysis, the surgical time (β = 0.395, p < 0.001), diameter of the largest myoma (β = 0.292, p = 0.03) and preoperative Hb concentration (β = 0.299, p < 0.001) predicted the postoperative Hb change.

Conclusions

Surgical time and dominant myoma diameter are independent predictors of the postoperative Hb drop after LM.