Ultrasonography in the prediction of complications during and after uterine myomectomy

Abstract

This study aims to evaluate the value of transvaginal sonography in the prediction of complications during and after myomectomy. Retrospective analysis of hysteroscopic, laparoscopic, and laparotomic myomectomies are called groups 1, 2, and 3, respectively, between January 2009 and August 2011. For each case, four ultrasonographic characteristics were collected: volume, vascularization, location, and presence of calcification(s). Outcome parameters were surgical time, intraoperative blood loss, embolisms, duration of hospital stay, pre- and postoperative hemoglobin, visceral damage (bladder, bowel, or uterus), fever, secondary hemorrhage, blood transfusion, and second-look surgery. Two-hundred ninety-five cases of hysteroscopic, 60 cases of laparoscopic, and 41 cases of laparotomic myomectomy were analyzed. The overall complication rates were 11.86, 16.67, and 36.59 %, respectively. In group 1, we found an association between volume and surgery time, blood loss, length of hospital stay, gas embolism, second-look surgery, and the risk of one or more complications. Myomas with volumes of 40 ml or more showed a higher complication rate than myomas with lower volumes. Higher vascularization correlated with more blood loss during surgery. In group 2, the volume of the myoma correlated with the difference between pre- and postoperative hemoglobin and hospital stay. In group 3, the number of removed myomas was a predictor for the length of hospital stay, the need for blood transfusion, and the risk on one or more complications. Transvaginal sonography can be used in the prediction of complications during and after myomectomy. In case of hysteroscopic or laparoscopic resection, the volume of the myoma is a significant predictor of complications. In case of laparotomic resection, the number of myomas that has to be removed is a predictor for the risks of complications.