Reproductive Outcomes after Laparoscopic Myomectomy: Conventional versus Barbed Suture.

ABSTRACT

STUDY OBJECTIVE: To study the reproductive outcomes after laparoscopic myomectomy comparing conventional (nonbarbed) suture with barbed suture used for myometrial defect closure. DESIGN: Monocentric retrospective cohort study with prospective follow-up survey for reproductive outcomes conducted in April and May 2020. SETTING: Tertiary care center (center for advanced gynecologic laparoscopy and infertility). PATIENTS Women who underwent laparoscopic myomectomy for uterine leiomyomas from January 2004 to December 2017. INTERVENTIONS: Laparoscopic myomectomy with closure of the myometrium using either conventional (nonbarbed suture) or barbed suture and follow-up survey regarding reproductive outcomes. MEASUREMENTS AND MAIN RESULTS: The outcomes measured included the rate of conception, pregnancy complications, mode of delivery, and perioperative complications for both kinds of suture materials used. Of the 399 women who underwent laparoscopic myomectomy, 343 satisfied the inclusion criteria and were followed up; 235 patients responded. A total of 120 patients were included in the nonbarbed group (group A), and 115 patients were included in the barbed group (group B). A total of 182 (group A 97 vs group B 85; p = .204) women had actively sought pregnancy postoperatively, of whom 93 (51.09%) in total and 51 (54.8%) in group A vs 42 (45.1%) in group B reported at least 1 pregnancy with no significant difference in the incidence rate ratios between the 2 groups. Of the recorded pregnancies84.9% (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 compared statistically between both study groups. Pregnancy-related complications were noted in 12 of the 93 pregnant women (12.9%), which were comparable in both groups. No case of uterine rupture was reported. CONCLUSION: Our study supports good reproductive outcomes in women after laparoscopic myomectomy with barbed sutures. Furthermore, the inclusion of nonbarbed sutures as a control group in our study reinforces that barbed sutures in myomectomy are as safe as, and an easier alternative to, conventional sutures without affecting pregnancy outcomes.