Incidence and Risk Factors for Intrauterine Adhesions Following Myomectomy

Abstract

Study Objective To determine the incidence & risk factors for intrauterine adhesions (IUA) following myomectomy. Design Retrospective cohort. Setting Academic practice. Patients or Participants 158 women undergoing robotic (RM), laparoscopic (LM), abdominal (AM) or hysteroscopic (HM) myomectomy between 2007-2017 with post-procedure hysteroscopy within 12 months of surgery were included. Women with a history of IUA were excluded. Interventions IUA's were ranked by two authors as minimal, moderate, or severe. Measurements and Main Results The most common indications for myomectomy were infertility (57%) abnormal uterine bleeding (39.9%), and pain/bulk symptoms (27.8%). The overall incidence of IUA was 10.1% (n=16), 75% of which were categorized as “minimal” and 25% as “moderate”. The incidence of IUA was highest for LM (14.3%), followed by HM (12.0%), AM (9.1%), and RM (8.8%). Women with a history of prior uterine surgery had more IUA's identified (12.5 vs 9.3%). Women with 1 fibroid removed had a similar incidence of IUA as those with 2-4 removed (8.7 vs 8.9%). Those with ≥ 5 fibroids had the highest incidence of IUA (11.9%). Women with at least 1 submucosal fibroid had an incidence of IUA of 14.6%. Those with at least 1 intramural fibroid had an incidence of 11.7%. Fibroids requiring ≥ 4 layers of closure had an IUA incidence of 14.6% compared to requiring Conclusion IUA can occur without intraoperative breech of the uterine cavity. Adenomyosis, 4-layer closure, ≥ 5 fibroids, and history of prior uterine surgery may increase risk for intrauterine adhesion formation, but larger studies are needed to definitively determine risk.