Among women undergoing uterus-preserving surgery for uterine fibroids, does laparoscopic myomectomy, compared with open (laparotomic) myomectomy, result in differences in length of hospital stay, postoperative morbidity and complications in a five-year single-center retrospective cohort?

Background Uterine fibroids are the most common benign tumors of the female reproductive tract and a major cause of gynecologic morbidity in women of reproductive age. For women wishing to preserve fertility, myomectomy remains the standard surgical treatment. Although laparoscopic myomectomy has increasingly replaced open abdominal myomectomy in selected patients, real-world comparative data on perioperative outcomes and postoperative morbidity remain limited. This study aimed to compare laparoscopic and open myomectomy in women undergoing uterus-preserving surgery, focusing on hospital stay, postoperative morbidity, and patient-centered outcomes. Methods This retrospective single-center cohort study included 207 women who underwent myomectomy for uterine fibroids at the Gynecology Department of the University Hospital in Tashkent between January 2020 and November 2025. Patients were divided into laparoscopic (n = 69) and open surgery (n = 138) groups. Women undergoing hysteroscopic myomectomy or hysterectomy and those with adenomyosis were excluded. Preoperative characteristics, fibroid features, perioperative outcomes, postoperative recovery, complications, and patient satisfaction were analyzed. Continuous variables were compared using Student’s t-test or the Mann–Whitney U test, and categorical variables using the chi-square or Fisher’s exact test. Statistical significance was defined as p < 0.05. Results The mean age of the study population was 40 ± 8 years. Open surgery was more frequently performed in women with larger and multiple fibroids, whereas laparoscopic procedures predominated in patients with smaller and fewer fibroids (p < 0.001). Length of hospital stay was significantly shorter in the laparoscopic group (p < 0.001), with 87.0% discharged within 1–2 days compared with 7.2% after open surgery. Postoperative recovery was significantly faster after laparoscopy (p = 0.013). Overall complication rates were comparable between groups (p = 0.716). Patient satisfaction was significantly higher following laparoscopic myomectomy (100% vs. 84.8%, p = 0.002), and laparoscopic surgery was associated with significantly smaller surgical scars (p < 0.001). Conclusions In this five-year single-center cohort, laparoscopic myomectomy was associated with shorter hospitalization, faster recovery, higher patient satisfaction, and superior cosmetic outcomes compared with open myomectomy, without increased postoperative complications. These findings support laparoscopic myomectomy as the preferred uterus-preserving surgical approach in appropriately selected patients