Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy

The purpose of this study was to compare, in infertile patients, the effica cy of laparoscopic myomectomy versus abdominal myomectomy, in restoring fer tility and to evaluate the obstetric outcomes. Between January 1993 and Jan uary 1998, 131 patients of reproductive age, with anamnesis of infertility, underwent myomectomy because of the presence of at least one large myoma ( diameter greater than or equal to5 cm), Patients were randomly selected for treatment by laparotomy (n = 65) or laparoscopy (n = 66), The two groups w ere homogeneous for number, size and position of large myomata, Significant differences mere found in the post-operative outcome: febrile morbidity (> 38 degreesC) was more frequent in the abdominal than in the laparoscopic gr oup (26.2 versus 12.1%; P < 0,05), Laparotomy caused a more pronounced haem oglobin drop (2.17 +/- 1.57 versus 1.33 +/- 1.23; P < 0.001); three patient s received a blood transfusion after laparotomy and none after laparoscopy. The post-operative hospital stay was shorter in the laparoscopic group (14 2.80 +/- 34.60 versus 75.61 +/- 37.09 h; P < 0.001). No significant differe nces were found between the two groups as concerns pregnancy rate (55.9% af ter laparotomy, 53.6% after laparoscopy), abortion rate (12.1 versus 20%), preterm delivery (7.4 versus 5%) and the use of Caesarean section (77.8 ver sus 65%). No case of uterine rupture during pregnancy or labour was observe d.