Comparison of Postoperative Complications Between Laparoscopic Myomectomy and Total Laparoscopic Hysterectomy.

STUDY OBJECTIVE: To compare postoperative complications of laparoscopic myomectomy (LM) with total laparoscopic hysterectomy (TLH). A secondary outcome examined whether complications differ by age. DESIGN: A retrospective cohort study. SETTING: A multicenter academic healthcare system. PATIENTS: Individuals > 18 years old undergoing LM from 2011 to 2021 or TLH for benign indications from 2020 to 2021. INTERVENTIONS: LM or TLH. MEASUREMENTS AND MAIN RESULTS: There were 1178 patients in the LM group and 1304 in the TLH group. Patients who underwent LM were younger, more often premenopausal, nonsmokers, with lower body mass index, lower preoperative hemoglobin, larger uterine size, and lower American Society of Anesthesiologists class. LM had longer operative times (154.1 ± 74.5 vs 145.9 ± 70.5 min, p <.0001), higher use of intraoperative hemostatic agents (25% vs 9.1%, p <.0001), and higher estimated blood loss (222.7 ± 313.0 vs 87.4 ± 145.9 mL, p <.0001) than TLH. Postoperatively, LM was associated with fewer surgical site infections (3.1% vs 5.8%, p <.0001), readmissions within 30 days (2.0% vs 5.6%, p <.0001), or emergency department visits within 90 days (10.9% vs 14.4%, p = .008). LM were more likely to be admitted 24 hours postoperatively (5.9% vs 3.4%, p = .0023) or receive a blood transfusion within 30 days (4.0% vs 1.0%, p <.0001). Variables associated with increased risk of postoperative complications were tobacco use, American Society of Anesthesiologists class > 3, preoperative anemia, estimated blood loss ≥ 150 mL, and specimen weight > 250 g. Logistic regression demonstrated that operative time ≥185 minutes was most strongly associated with 24-hour admission postoperatively (odds ratio [OR] = 12.95; 95% confidence interval [CI], 3.71-45.27). In individuals ≤ 37 years of age, the LM group was less likely than the TLH group to experience surgical site infection (OR, 0.30; 95% CI, 0.14-0.62) or present to the emergency department (OR, 0.40; 95% CI, 0.26-0.63). CONCLUSION: In this large cohort of patients, both LM and TLH had low rates of postoperative complications, but the complications differed for each approach. In appropriate surgical candidates, either approach may be offered based upon patients' goals.

Effect of Immediate Loop Electrode Excisional Procedure for High-Grade Cervical Cytology in an Urban Academic Clinic Setting.

OBJECTIVE: The aim of the study was to determine whether treating all patients older than 25 years with high-grade squamous intraepithelial lesion (HSIL) Paps with immediate loop electrode excisional procedure (LEEP) improves rates of receiving indicated treatment and evaluating whether this practice results in overtreatment (defined by excisional pathology less than cervical intraepithelial neoplasia 2). MATERIALS AND METHODS: This was a retrospective cohort study at an urban, Medicaid-based clinic, which evaluated women older than 25 years with HSIL Pap results seen from June 2011 to December 2016. In June 2013, the clinic practice was restructured and management of HSIL Pap results in patients older than 25 years was standardized to immediate LEEP procedure, without intermediate colposcopic examination. Our primary outcome is the number of women who received LEEPs before and after this clinical practice change. The secondary outcome evaluated the number of women who received overtreatment. The χ test with a p value of 0.05 as significant was used to compare the results between groups. RESULTS: Twenty-three (82%) of the 28 women treated before clinical practice change received indicated treatment, with 19 receiving LEEPs. Twenty-four (96%) of the 25 women treated after the clinical practice change received indicated LEEPs (p = .11). Seven (37%) of the 19 women in the initial group had LEEP pathology results less than CIN 2, whereas only 4 (17%) of the 24 women in the immediate LEEP group had results less than CIN 2 (p = .13). CONCLUSIONS: Implementation of a standardized management of HSIL Pap with immediate LEEP did not statistically increase the amount of patients who received indicated LEEPs; however, implementation of this practice did not result in overtreatment.