Perioperative and reproductive outcomes’ comparison of mini-laparotomy and laparoscopic myomectomy in the management of uterine leiomyomas: a systematic review

• Published in: Archives of gynecology and obstetrics Vol. 309; no. 3; pp. 821 - 829
• Main Authors: Tsiampa, Eleni, Tsiampas, Konstantinos, Kapogiannis, Filippos
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-03-2024; Springer Nature B.V
• Subjects: Case-Control Studies; Cesarean Section; Endocrinology; Female; Fibroids; Gynecology; Human Genetics; Humans; Infant, Newborn; Laparoscopy; Laparoscopy - methods; Laparotomy; Laparotomy - methods; Leiomyoma - complications; Lipopolysaccharides; Medicine; Medicine & Public Health; Obstetrics/Perinatology/Midwifery; Pregnancy; Prospective Studies; Retrospective Studies; Review; Uterine Myomectomy - methods; Uterine Neoplasms - complications; Mini-laparotomy; Gasless laparoscopic myomectomy; Uterine leiomyoma; Laparoscopic myomectomy
• ISSN: 1432-0711; 0932-0067; 1432-0711
• DOI: 10.1007/s00404-023-07168-5

Objective
To evaluate and compare mini-laparotomy (MLPT) with laparoscopic (LPS) myomectomy perioperative and reproductive outcomes.
Methods
We systematically searched for related articles in the MEDLINE, Embase, Web of Science and the Cochrane library databases. Nine studies (4 randomized, 3 retrospective, 1 prospective and 1 case–control study) which involved 1723 patients met the inclusion criteria and were considered eligible for inclusion.
Results
Demographic characteristics were similar between the two groups. LPS was associated with shorter hospital stay (
p
 = 0.04), lower blood loss (
p
 < 0.00001), shorter duration of median ileus (
p
 < 0.00001) and fewer episodes of postoperative fever (
p
 = 0.04). None of the reproductive factors examined (pregnancy rate, preterm delivery, vaginal delivery and delivery with caesarean section) in women diagnosed with unexplained infertility and/or symptomatic leiomyomas reached statistical significance although the results represent a small size effect.
Conclusion
Our analysis demonstrated that LPS seems to be an alternative, safe and reliable surgical procedure for uterine leiomyoma treatment and in everyday practice seems to offer improved outcomes—regarding at least the perioperative period—over MLPT.