Early outcome of myomectomy by laparotomy, minilaparotomy and laparoscopically assisted minilaparotomy. A randomized prospective study.
BACKGROUND
To compare in the first 7 days after surgery the outcome of myomectomy performed by three laparotomic approaches: laparotomy (LT), minilaparotomy (MLT) and laparoscopically assisted minilaparotomy (LA-MLT).


METHODS
Fifty-one women with 5-15 cm total myoma diameter were randomized blindly using a computer randomization list, to LT (n = 17), MLT (n = 17) or LA-MLT (n = 17).


RESULTS
Mean operation length was similar in the three groups. Mean (+/- SEM) time of paralytic ileus (55.0 +/- 4.5 versus 33.4 +/- 3.4 h; P < 0.01) and discharge (141.6 +/- 5.2 versus 81.5 +/- 8.2 h; P < 0.01) was longer in LT than LA-MLT or even MLT. In comparison with LA-MLT, LT induced a greater haemoglobin decline (-3.07 +/- 0.3 versus -1.8 +/- 0.15 mg/dl; P < 0.025), and a greater post-operative stress, as documented by increased prolactin (+15.1 +/- 3.8 versus +0.16 +/- 4.5 ng/ml; P < 0.03) and decreased insulin sensitivity (fasting glucose/insulin; -7.5 +/- 2.6 versus -0.7 +/- 2.1; P < 0.02). Seven days after surgery, abdominal pain (P < 0.05) was higher after LT (3.0 +/- 0.6) than MLT (0.5 +/- 0.2) and LA-MLT (0.9 +/- 0.4).


CONCLUSIONS
In selected cases, myomectomy by LA-MLT offers some advantages versus LT and, to a smaller extent, MLT.
Cagnacci
A
A
Institute of Obstetrics and Gynaecology, Policlinico di Modena, Via del Pozzo, 71 41100 Modena, Italy. cagnacci@unimore.it
Pirillo
D
D
Malmusi
S
S
Arangino
S
S
Alessandrini
C
C
Volpe
A
A
D015746:Abdominal Pain; D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007328:Insulin / Q000097:blood; D010535:Laparoscopy; D007813:Laparotomy; D007889:Leiomyoma / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011388:Prolactin / Q000097:blood; D011446:Prospective Studies; D013997:Time Factors; D014594:Uterine Neoplasms / Q000601:surgery*
D001786:Blood Glucose; D006454:Hemoglobins; D007328:Insulin; D011388:Prolactin; D006854:Hydrocortisone