Evaluation of factors contributing to uterine scar formation after laparoscopic myomectomy.

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.