Intrauterine adhesions after open myomectomy: an audit

Abstract

Objective: To estimate the incidence of intrauterine adhesions after open myomectomy.

Study design: A prospective audit descriptive study was conducted involving thirty-six women who had undergone open myomectomy for symptomatic fibroids at a large undergraduate teaching hospital. A follow-up out-patient hysteroscopy was performed three months after surgery.

Results: At hysteroscopy, eighteen patients (50%) were found to have mild to moderate intrauterine adhesions. The number of fibroids removed was significantly higher in patient who developed adhesions (median value 22 versus 9.5, p<0.05). Pre-operative GnRHa therapy, uterine size, opening of the uterine cavity during surgery, specimen weight, estimated blood loss, post-operative bleeding or pyrexia were similar whether or not adhesions were found.

Conclusion: Open myomectomy represents an important but currently underappreciated aetiological factor in the formation of intrauterine adhesions.

Keywords: Hysteroscopy; Intrauterine adhesions; Open myomectomy; Surgical technique; Uterine myomas.