Abstract
To evaluate the factors associated with complete myomectomy in a single surgical procedure and the aspects related to the early complications. A cross-sectional study with women with submucous myomas. The dependent variables were the complete myomectomy performed in a single hysteroscopic procedure, and the presence of early complications related to the procedure. We identified 338 women who underwent hysteroscopic myomectomy. In 89.05% of the cases, there was a single fibroid to be treated. According to the classification of the International Federation of Gynecology and Obstetrics (Fédération Internationale de Gynécologie et d'Obstétrique, FIGO, in French), most fibroids were of grade 0 (66.96%), followed by grade 1 (20.54%), and grade 2 (12.50%). The myomectomies were complete in 63.31% of the cases, and the factors independently associated with complete myomectomy were the diameter of the largest fibroid (prevalence ratio [PR]: 0.97; 95% confidence interval [95%CI]: 0.96-0.98) and the classification 0 of the fibroid according to the FIGO (PR: 2.04; 95%CI: 1.18-3.52). We observed early complications in 13.01% of the hysteroscopic procedures (4.44% presented excessive bleeding during the procedure, 4.14%, uterine perforation, 2.66%, false route, 1.78%, fluid overload, 0.59%, exploratory laparotomy, and 0.3%, postoperative infection). The only independent factor associated with the occurrence of early complications was incomplete myomectomy (PR: 2.77; 95%CI: 1.43-5.38). Our results show that hysteroscopic myomectomy may result in up to 13% of complications, and the chance of complete resection is greater in small and completely intracavitary fibroids; women with larger fibroids and with a high degree of myometrial penetration have a greater chance of developing complications from hysteroscopic myomectomy.
Highlights
Uterine fibroids are benign monoclonal tumors composed of smooth muscle cells mixed with different amounts of extracellular matrix, arising in the myometrium.[1,2] Fibroids are the most frequent benign tumors in women of reproductive age, and the prevalence rates vary between 20% and 50%.3,4 almost always benign[5] and with a low rate of cell proliferation in vivo, they can lead to increased uterine bleeding, pelvic pain and infertility,[3] depending on their size and location within the uterus
Our results show that hysteroscopic myomectomy may result in up to 13% of complications, and the chance of complete resection is greater in small and completely intracavitary fibroids; women with larger fibroids and with a high degree of myometrial penetration have a greater chance of developing complications from hysteroscopic myomectomy
We identified 338 women who underwent hysteroscopy for the treatment of uterine fibroids
Summary
Uterine fibroids are benign monoclonal tumors composed of smooth muscle cells mixed with different amounts of extracellular matrix, arising in the myometrium.[1,2] Fibroids are the most frequent benign tumors in women of reproductive age, and the prevalence rates vary between 20% and 50%.3,4 almost always benign[5] and with a low rate of cell proliferation in vivo, they can lead to increased uterine bleeding, pelvic pain and infertility,[3] depending on their size and location within the uterus. Almost always benign[5] and with a low rate of cell proliferation in vivo, they can lead to increased uterine bleeding, pelvic pain and infertility,[3] depending on their size and location within the uterus. For women with submucosal myomas, myomectomy through hysteroscopy is an option that enables uterine preservation,[6] and it is currently considered the procedure of choice for the treatment of this disease.[7] Before the advent of hysteroscopy, many intrauterine diseases were treated with more invasive procedures, with greater risks and costs, such as laparotomy and hysterectomy, or less resolution, such as dilation and curettage.[8] among the procedures that can be performed by hysteroscopy, myomectomy has one of the highest complication rates.[9]
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