Reproductive Outcomes after Laparoscopic Myomectomy: Conventional versus Barbed Suture.

Abstract

STUDY OBJECTIVE\nTo study the reproductive outcomes after laparoscopic myomectomy comparing conventional (non-barbed) suture with barbed suture, used for myometrial defect closure.\n\n\nDESIGN\nMonocentric retrospective cohort study with prospective follow up survey for reproductive outcomes conducted in April-May 2020.\n\n\nSETTING\nTertiary care center (Center for advanced gynecological laparoscopy and infertility) PATIENTS: Women who underwent laparoscopic myomectomy for uterine leiomyomas from January 2004 - December 2017.\n\n\nINTERVENTION\nLaparoscopic myomectomy with the closure of myometrium using either conventional (non-barbed sutures) or barbed sutures and follow-up survey regarding reproductive outcome.\n\n\nMEASUREMENTS\nRate of conception, pregnancy complications, mode of delivery, perioperative complications for both kinds of suture materials used.\n\n\nRESULTS\nOf 399 women who underwent laparoscopic myomectomy, 343 patients satisfied the inclusion criteria were followed up, and 235 patients responded. 120 patients were in the non-barbed group (group A) and 115 patients in the barbed group (group B). 182 (Group A 97 vs. Group B 85; p-value .204) women had actively sought pregnancy post-operatively, of which 93 patients (51.09%) in total and 51 (54.8%) in group A Vs. 42 (45.1%) in group B reported at least one pregnancy with no significant difference in incidence rate ratios between the two groups. Of the recorded pregnancies, 84.9 % (group A 88.2% vs. group B 80.9%) live births, 6.4 % (group A 5.8% Vs. group B 7.1%) had first trimester miscarriages, 2.1 % (group A 1.9% vs. group B 2.3%) had an ectopic pregnancy and 6 were ongoing pregnancies at the time of the study analysis which were analyzed and compared statistically in both the study groups. The pregnancy-related complications were noted in 12 out of 93 pregnant women (12.9%), which were comparable in both the groups, and no cases of uterine ruptures were reported.\n\n\nCONCLUSION\nOur study supports the good reproductive outcome of women after laparoscopic myomectomy with barbed sutures. Further, the inclusion of non-barbed sutures as a control group in our study reinforces that barbed sutures in myomectomy are equally safe and an easier alternative to conventional sutures without affecting the pregnancy outcomes.