Old- versus New-School: Laparoscopy versus Laparotomy in Complex and Multiple Myomectomies

Background Complex myomectomies involving large myomas more than 10cm and multiple myomas are considered challenging in laparoscopic surgery. The aim of this original study is to compare the fertility outcomes and complications of laparotomy versus laparoscopy in complex myomectomies. Methods Retrospective study approved by the Brugmann University Hospital’s ethics committee (CE2023/79). Complex myomectomies were defined as single fibroids larger than 10cm and multiple fibroids. Ninety-four patients (mean-age-35-years) included. The laparoscopic and laparotomic myomectomy groups consisted of 54 and 40 patients respectively. Normality of data was assessed by Q-Q plot, when normality was not ascertained comparisons were carried out using the Mann-Whitney tests for unpaired comparisons, or Wilcoxon otherwise. When normality was reached t-tests for paired or unpaired comparisons were preferred. Results The peri-operative blood loss is significantly higher when the surgical approach used was laparotomy (700 vs 500 mL, p = 0.031), associated with a greater drop in hemoglobin (2.3 vs 2.1, p = 0.081) and a higher transfusion rate (0.13% vs 0.06%, p = 0.486). Median surgery time was shorter (180 min. vs 240 min., p = 0.0002) and hospital stay longer (3 days vs. 2 days, p < 0.0001) in the laparotomy group. The laparotomy conversion rate was 3,2%. In multiple linear regression analysis, blood loss appears to be significantly influenced by the number of fibroids and the fibroids’ weight. Hospital stay appears to be significantly influenced by the patients age, the fibroids’ weight, and the surgery time. Thirty-two percent of patients achieved pregnancy post-surgery, with no statistically significant differences between the two groups in terms of pregnancy success rates (p = 0.5304). Conclusion These results show that even in complex myomectomies, laparoscopic approach could still be the first line of treatment. Laparoscopic myomectomy does not signify higher risks or complications and has significantly lower risk of bleeding and hospitalisation time without compromising fertility outcomes.