Preoperative relugolix combination therapy in laparoscopic myomectomy: a case series evaluating impact on surgical planes and operative outcomes
Gonadotropin-releasing hormone (GnRH) receptor antagonists in combination therapy offer a promising advancement in the medical management of uterine fibroids. While effective for symptom control, limited data exist on their impact on surgical outcomes, particularly during laparoscopic myomectomy. This case series describes the surgical findings in three patients who received preoperative Relugolix combination therapy (Relugolix-CT: relugolix-estradiol-norethisterone acetate) compared to no pretreatment. We conducted a retrospective review of 24 patients who underwent laparoscopic myomectomy over a 6-month period. Three patients received a preoperative course of Relugolix-CT for 3, 6, and 9 months, respectively, while 21 patients underwent surgery without pretreatment. Blood loss was lower in the Relugolix-CT group (216.6 mL ± 189.7) vs. the no-pretreatment group (354.8 mL ± 131.9. Operating time was similar (148.3 vs. 148.1 min), as was duration of inpatient stay (1.3 vs. 2.0 days). No complications occurred in either group. Notably, in all cases with Relugolix-CT pretreatment, no distortion or fibrosis of the fibroid pseudocapsule was noted, allowing for complete resection of the fibroids. This case series suggests that preoperative Relugolix-CT does not adversely affect surgical planes or operative outcomes. Although preliminary, these findings suggest benefits for surgical optimisation and support further investigation in larger, controlled studies.