Unveiling the advantages of laparoscopic myomectomy: A comprehensive systematic review and meta-analysis of outcomes and complications compared with traditional open surgery

Abstract

Aims: To compare the outcomes of laparoscopic myomectomy (LM) and open myomectomy (OM) by reviewing the frequency, type and severity of complications reported by the Clavien-Dindo classification. In addition, this study evaluated differences in blood loss, length of operative time and hospital stay between these two surgical approaches.

Methods: A systematic search of electronic databases was conducted from their inception to January 2024 to identify studies comparing LM and OM with detailed surgical complications reported. The random effect model was applied, and the odds ratio was used for the main outcomes, with effect sizes presented alongside 95 % confidence intervals (CI). A p-value < 0.05 was considered to indicate significance.

Results: Of 296 studies identified, nine studies (total 224 patients) were included. LM was found to be associated with significantly lower rates of overall postoperative complications compared with OM. With no statistical heterogeneity between the studies (I² = 0 %), the overall effect size was 0.67 (95 % CI 0.45-0.99), indicating a significant association between postoperative complications and open surgery (p = 0.04). Regarding Clavien-Dindo complications >grade 3, the overall effect size was 1.55 (95 % CI 0.47-5.08), indicating a non-significant association between grade 3 complications and surgical approach (p = 0.47). Despite superimposable operative time (effect size 1.40, 95 % CI 0.70-2.79; p = 0.342), LM showed significantly lower mean blood loss compared with OM, with an overall effect size of 0.34 (95 % CI 0.12-1.00; p = 0.049). The duration of hospital stay was significantly shorter in the LM group (2.0 vs 3.1 days), with an overall effect size of 0.09 (95 % CI 0.05-0.18), strongly associating the laparoscopic approach with reduced hospitalization stay (p < 0.001).

Conclusion: LM offers favourable outcomes compared with OM for the treatment of uterine myomas. Despite a slightly longer operative time, LM was found to be associated with lower rates of postoperative complications and reduced hospital stay. These findings support the preference for LM for the treatment of uterine myomas, highlighting its potential to improve patient outcomes and recovery.

Keywords: Complications; Laparoscopy; Laparotomy; Meta-analysis; Myomectomy.