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Laparoscopic Occlusion May Offer Better Pregnancy Outcomes


 

ORLANDO — Laparoscopic uterine artery occlusion is an effective way to manage patients with symptomatic fibroids, and may offer better outcomes than uterine artery embolization for women desiring pregnancy after the surgery, Dr. Zdenek Holub said at a meeting on laparoscopy and minimally invasive surgery.

In a prospective follow-up study, Dr. Holub found only a 9% miscarriage rate among women who became pregnant after the procedure.

That compares very favorably with the 14% rate he and his colleagues found in a previous study they performed of uterine artery embolization for symptomatic fibroids, he said.

The laparoscopic occlusion study included 161 women (mean age 37 years). All of them had one to three symptomatic fibroids with a mean size of 6 cm. The mean follow-up time was 34 months, with postoperative visits at 3, 6, and 12 months, followed by yearly visits.

The mean operative time was 35 minutes, and patients had minimal blood loss, said Dr. Holub, chairman of obstetrics and gynecology at the Baby Friendly Hospital in Kladno, Czech Republic.

Postoperative complications occurred in 11 patients, and included port-site bleeding, hemorrhage, fever, and fibroid necrosis. There were no life-threatening complications.

At 12 months' follow-up, the mean reduction in fibroid volume was 56%, with the size of the dominant fibroid reduced by a mean of 72%. At 34 months, 87% of the group was without fibroid recurrence.

Sixty-three patients desired pregnancy after their surgery. A total of 32 pregnancies occurred; 29 women conceived naturally. There were three miscarriages (9%).

The preterm delivery rate was 10%, and 50% of the babies were delivered by cesarean section

“Our miscarriage rate was significantly lower than the rate we see associated with uterine artery embolization in the literature,” said Dr. Holub at the meeting sponsored by the Society of Laparoendoscopic Surgeons. “In a control group of women who got embolization at our hospital, we had a 14% miscarriage rate.”

A more detailed account of the study has been published (Int. J. Gynaecol. Obstet. 2007;1:44–5).

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