Long-term results of laparoscopic myomectomy: recurrence rate in comparison with abdominal myomectomy

Laparoscopic myomectomy is still a debated procedure and there are conflict ing opinions regarding the recurrence rate. Laparoscopic myomectomy may pre sent a higher risk of recurrence compared with abdominal myomectomy, The ai m of this investigation was to analyse the recurrence rate of myomas after surgery. From January 1991 to June 1998, 165 myomectomies were performed fo r symptomatic myomas measuring at least 3 cm in diameter and numbering seve n or less per patient. During the first 3 years of this survey, 81 patients were randomized for abdominal or laparoscopic myomectomy. Transvaginal ult rasound examination was performed within 15-30 days of surgery and every 6 months for a post-operative period of 40 months. The two groups had similar pre-operative clinical features and the number and volume of myomas did no t differ between the two groups. At the end of the study the group of abdom inal myomectomies showed nine recurrences (23%) against 11 (27%) of the lap aroscopic group. In order to evaluate the recurrence rate in relation to se veral risk factors, laparoscopic myomectomies were performed from 1991 in 8 4 patients who agreed to follow-up (and were not in the randomized group). Of these, 78 patients were evaluated with transvaginal ultrasound for a mea n interval of 26 months and 17 (21.78%) recurrences were found. Most recurr ences (75%) were seen at ultrasound between 10 and 30 months after surgery. The patient's age, pre- and post-operative gravidity and parity had no inf luence on recurrence. Neither the number of myomas removed nor the depth of penetration or size were positively associated with the risk of recurrence . However, an associated risk factor was pre-operative gonadotrophin-releas ing hormone agonist treatment (P < 0.02). None of the women with recurrence required additional surgery. We conclude that laparoscopic myomectomy is a reliable procedure. The recurrence rate is similar to that seen after abdo minal myomectomy.