Evaluation of factors contributing to uterine scar formation after laparoscopic myomectomy

Abstract

OBJECTIVE: To evaluate factors contributing to uterine scar formation after laparoscopic myomectomy (LM) and to estimate whether uterine scarring indicated risk of uterine rupture. DESIGN: Retrospective study. SETTING: University-affiliated hospital. POPULATION: A total of 692 patients who underwent second-look laparoscopy (SLL) after LM. METHOD: Video-tape recording during SLL to evaluate the conditions of uterine suture wound healing, with univariate and logistic regression analysis. MAIN OUTCOME MEASURES: Correlation between scar formation and operative findings at LM. Factors influencing scar formation in 305 patients with an enucleated solitary myoma. RESULTS: SLL revealed that 628 patients (90.8%) had a normal uterus and 64 patients (9.2%) had a scarred uterus. Deformation of the endometrium found by preoperative imaging and complete myometrial penetration during LM had a positive correlation and the number of enucleated myomas a negative correlation with scar formation. Significant factors associated with scar formation were complete myometrial penetration (odds ratio, 2.53; 95% confidence interval, 1.30-4.93; p = 0.006) and enucleation of a subserosal myoma (odds ratio, 0.23; 95% confidence interval, 0.08-0.70; p = 0.009). Of the 98 patients who delivered, none suffered a uterine rupture regardless of the presence of a uterine scar. CONCLUSIONS: Uterine scar formation after LM correlated with the degree of myometrial penetration. However, the presence of a uterine scar did not appear to influence the delivery outcome.