Şafak Hatırnaz1, Oğuz Güler2, Alper Başbuğ3, Mehmet Bilge Çetinkaya4, Mine Kanat-Pektaş5, Kadir Bakay4, Samettin Çelik6, Şenol Şentürk7, Canan Soyer-Çalışkan6, Aysemin Gürçağlar8, Banuhan Şahin8, Üzeyir Kalkan9, Handan Çelik4, Şenol Kalyoncu10, İsmail Bıyık11, Murat Yassa12, Onur Erol13, Süleyman Akarsu14, Uğur Turhan6, Hasan Ulubaşoğlu6, Radmila Sparic15,16, Andrea Tinelli17,18. 1. Medicana Samsun International Hospital, IVF Center, Sansun, Turkey. 2. Department of Obstetrics and Gynecology, Bilge Hastanesi, Istanbul, Turkey. 3. Department of Obstetrics and Gynecology, School of Medicine, Duzce University, Duzce, Turkey. 4. Department of Obstetrics and Gynecology, School of Medicine, Ondokuzmayis University, Samsun, Turkey. 5. Department of Obstetrics and Gynecology, School of Medicine, Kocatepe University, Afyon, Turkey. 6. Maternity Hospital, Samsun Training and Research Hospital, Samsun, Turkey. 7. Department of Obstetrics and Gynecology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey. 8. Department of Obstetrics and Gynecology, School of Medicine, Amasya University, Amasya, Turkey. 9. Department of Obstetrics and Gynecology, Özel Egemed Hospital Söke, Aydın, Turkey. 10. Department of Obstetrics and Gynecology, Private Office, Ankara, Turkey. 11. Department of Obstetrics and Gynecology, Kütahya Sağlık Bilimleri Üniversitesi, Kütahya, Turkey. 12. Department of Obstetrics and Gynecology, Sağlık Bilimleri Üniversitesi, Şişli Etfal Hastanesi, İstanbul, Turkey. 13. Department of Obstetrics and Gynecology, Sağlık Bilimleri Üniversitesi, Antalya Eğitimve Araştırma Hastanesi, Antalya, Turkey. 14. Medicana Ankara Hastanesi, Ankara, Turkey. 15. Clinic of Gynecology and Obstetrics, Clinical Center of Serbia, Višegradska, Serbia. 16. School of Medicine, University of Belgrade, Serbia. 17. Department of Obstetrics and Gynecology, Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Lecce, Italy. 18. Laboratory of Human Physiology, PhystechBioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russia.
Abstract
OBJECTIVE: This multi-center study aims to determine the efficiency and safety of endometrial myomectomy (EM) for the removal of uterine fibroids during cesarean section (CS). METHODS: Retrospective review of 360 women diagnosed for fibroids during pregnancy. They all delivered by CS between 2014 and 2019. The study groups included 118 women who only underwent EM, 120 women who only had subserosal myomectomy by traditional technique and 122 women with fibroids who decided to avoid cesarean myomectomy, as control group. They were analyzed and compared the surgical outcomes. RESULTS: The EM, subserosal myomectomy and control groups were statistically (p > 0.05) similar for to age, body mass index (BMI), gravidity, parity, gestational age at delivery, indications for CS, number of excised fibroids, size of the largest myoma. Postoperative hemoglobin values and ? (?) hemoglobin concentrations were lower in SM group (10.39gr/dl vs 9.98 gr/dl vs 10.19 - 1.44 gr/dl vs 1.90 gr/dl vs 1.35; p = 0.047, p = 0.021; respectively) Hybrid fibroids were significantly more frequent in the EM group than subserosal myomectomy and control groups (respectively, 33.1% vs 23.3% vs 27.0%, p = 0.002). Surgery time was significantly longer in the subserosal myomectomy group than EM and control groups (respectively, 46.53 min vs 37.88 min vs 33.86 min, p = 0.001). Myomectomy took significantly longer time in the subserosal myomectomy than EM group (13.75 min vs 8.17 min, p = 0.001). CONCLUSIONS: Endometrial myomectomy is a feasible choice for treatment of fibroids during CS, and, basing on our results could be an alternative to traditional cesarean subserosal myomectomy.
OBJECTIVE: This multi-center study aims to determine the efficiency and safety of endometrial myomectomy (EM) for the removal of uterine fibroids during cesarean section (CS). METHODS: Retrospective review of 360 women diagnosed for fibroids during pregnancy. They all delivered by CS between 2014 and 2019. The study groups included 118 women who only underwent EM, 120 women who only had subserosal myomectomy by traditional technique and 122 women with fibroids who decided to avoid cesarean myomectomy, as control group. They were analyzed and compared the surgical outcomes. RESULTS: The EM, subserosal myomectomy and control groups were statistically (p > 0.05) similar for to age, body mass index (BMI), gravidity, parity, gestational age at delivery, indications for CS, number of excised fibroids, size of the largest myoma. Postoperative hemoglobin values and ? (?) hemoglobin concentrations were lower in SM group (10.39gr/dl vs 9.98 gr/dl vs 10.19 - 1.44 gr/dl vs 1.90 gr/dl vs 1.35; p = 0.047, p = 0.021; respectively) Hybrid fibroids were significantly more frequent in the EM group than subserosal myomectomy and control groups (respectively, 33.1% vs 23.3% vs 27.0%, p = 0.002). Surgery time was significantly longer in the subserosal myomectomy group than EM and control groups (respectively, 46.53 min vs 37.88 min vs 33.86 min, p = 0.001). Myomectomy took significantly longer time in the subserosal myomectomy than EM group (13.75 min vs 8.17 min, p = 0.001). CONCLUSIONS: Endometrial myomectomy is a feasible choice for treatment of fibroids during CS, and, basing on our results could be an alternative to traditional cesarean subserosal myomectomy.