Laparoscopic Versus Open Myomectomy and Fertility - A Meta-Analysis

Background: Fibroids (leiomyomata or myomas) are themost common benign tumours of the female genital tract and may have a negative effect on fertility. In women with symptomatic fibroids wishing to conserve fertility thefibroids can be surgically removed with preservation of the uterus (myomectomy). This operation is achieved by laparotomy, laparoscopically or hysteroscopically depending onthesite, size and type of myoma. However, myomectomy is a procedure that is not without risk and may, on occasion, result in serious complications. Therefore, it is essential to detect whether this procedure can improve fertility and, if so, to determine the ideal surgical approach.

Laparoscopicmyomectomy, in subfertile patients, is a common surgical procedure. Despite the observation that the laparoscopicapproach to myomectomy has many advantages, its role ininfertility treatment remains controversial.

Aim: To undertake a systematic review to examine the effect of laparoscopic myomectomy on fertility outcomes compared with abdominal myomectomy.

Methods: The following databases were used in this review: PubMed Central, Medline, BioMed Central, CINAHL with Full Text (EBSCO), , ScienceDirect – Full text only, Cochrane library ,Google search in general and Google scholarly. Studies which met the inclusion criteria were selected and analysed.

Results: The evidence from two randomised control trials suggests that there is no significant difference between laparoscopic and open myomectomy for large myomas with respect to fecundity for women in the reproductive age group. This evidence requires cautious interpretation because of the small number of studies available. Thus more studies are required to add power to the findings. Many surgeons prefer the laparoscopic approach, if it is practicable because of the proven benefits including less post operative pain, less fever, reduced blood loss, enhanced recovery and shorter length of hospital stay. There is paucity of data regarding the effect on fertility and our meta-analysis attempts to clarify this gap in the literature.

Keywords: preterm, rupture, membranes, neonatal, outcome.