Incidence of Intrauterine Adhesions After Myomectomy and Association With Intraoperative Entry of the Endometrial Cavity
To estimate the incidence of intrauterine adhesions (IUA) after myomectomy. We conducted a retrospective cohort study of women who underwent either an abdominal, laparoscopic, laparoscopic and hysteroscopic, or robotic myomectomy at Medstar Washington Hospital Center. Patients underwent office hysteroscopy (OH) 3 months post myomectomy as postoperative surveillance for detection of IUA. All myomectomies were performed by a single minimally invasive gynecologic (MIGS) fellowship-trained surgeon. The surgical approach was chosen using factors such as patients' past medical and surgical history, and fibroid size, number, and location. Patients older than 18 who had received either an abdominal, laparoscopic, laparoscopic and hysteroscopic, or robotic myomectomy at Medstar Washington Hospital Center between 2015 and 2022 were included. Patients who received additional hysteroscopic procedures outside of myomectomy that could confound calculation of IUA incidence were excluded. OH performed 3 months following myomectomy. Four hundred and twenty-two myomectomy patients were included in the analysis (69 abdominal, 275 laparoscopic, 54 laparoscopic and hysteroscopic, and 24 robotic). Of these, 282 patients (66.8%) presented for OH 3 months postoperatively. The overall incidence of IUA after myomectomy was 17.4%; incidence was 35.6% in the abdominal group, 9.7% in the laparoscopic group, 29% in the laparoscopic combined with hysteroscopic group, and 11.8% in the robotic group. Intraoperative entry into the endometrial cavity was significantly associated with development of IUA with an adjusted odds ratio of 4.88. Based on OH, 17% of the current study cohort had IUA 3 months following myomectomy. OH is a minimally invasive approach for diagnosis and treatment which was accepted by the majority of patients in our cohort. Risk counseling about IUA following myomectomy is important particularly in light of recent data describing increased pregnancy risk in patients with IUA, including placenta accreta spectrum disorders.
