Is fibroid location associated with hemorrhage and complication rates following laparoscopic myomectomy?

Abstract

Objective: to determine whether hemorrhage and complication rates vary according to the location of the dominant fibroid following laparoscopic myomectomy. Background: laparoscopic myomectomy is associated with less postoperative pain, analgesic requirement, shorter hospitalization period, and less febrile complications when compared to conventional laparotomy. Despite the advantages, complications like hemorrhage, blood transfusion, bowel and urinary tract injury, and conversion to laparotomy may be seen in laparoscopic myomectomy. We do not know whether the fibroid location affects these complications. Materials and methods: women, who underwent laparoscopic myomectomy at two different tertiary academic hospitals, were analyzed retrospectively. Only women with at least one intramural fibroid (Monroe type 3, 4, or 5) were included. Patients were categorized according to localization of the dominant fibroid, i.e., anterior uterine wall, posterior uterine wall, and fundus. Change in hemoglobin levels before and after surgery and complication rates were compared across categories. Results: two hundred nineteen women with a mean age of 35.7 +/- 6 years were included. There were 81 women with fundal fibroid, 56 with anterior wall, and 72 with posterior wall fibroid. The other ten women with intraligamentary and isthmic fibroid were excluded. The mean fibroid diameter was 6.7 +/- 2.6, 6.6 +/- 2.3, and 6.7 +/- 2.3 cm in the fundal, anterior, and posterior groups, respectively (p = 0.9). The median (25th-75th percentile) changes in hemoglobin levels were 1.5 (0.8-2.2), 1.3 (0.6-2.1), and 1.3 (0.9-2) g/dl in fundal, anterior, and posterior wall groups, respectively (p = 0.55). There were 5 (6.2%), 5 (8.9%), and 2 (2.8%) complications in fundal, anterior, and posterior wall groups, respectively (p = 0.33). Conclusion: the incidence of hemorrhage or complication does not seem to vary depending on the fibroid location. However, the sample size was limited; observed values suggest that fibroid location does not affect hemorrhage and complication rates.