Effects of selective blockage of utero-ovarian anastomoses on clinical results of uterine artery occlusion.
BACKGROUND
We assessed the results and impact of blockage of utero-ovarian anastomoses (UOA) on clinical outcome in women treated by laparoscopic uterine artery occlusion for uterine fibroids.


METHODS
Between 2004 and 2005, we prospectively analyzed the clinical data for 23 laparoscopic uterine artery occlusion cases combined with blockage of utero-ovarian anastomoses (Group A) and 67 laparoscopic uterine artery occlusion cases alone (Group B).


RESULTS
Of these 23 patients with UOA (mean age, 36.7+/-2.8 years), 10 patients (43.4%) had anastomoses bilaterally and 13 patients (56.6%) had unilateral anastomoses. Mean fibroid size reduction after LUAO and anastomoses blockage was 32.5% from baseline (P<0.001). In patients with LUAO, the mean DF size after surgery was estimated at 38.7+/-19.2 mm, which translated to a mean fibroid size reduction of 30.6% from baseline (P<0.001). No case of clinical failure or recurrence was found in Group A patients with UOA (mean follow-up, 15.6 months), who were treated with combined surgery. At a mean clinical follow-up of 18.2 months (Group B), 6 patients (8.9%) elected to undergo further surgical intervention for clinical failure and recurrence, including 4 myomectomies and 2 hysterectomies. The statistical difference between groups was not significant (P=0.33).


CONCLUSIONS
Laparoscopic blockage of utero-ovarian anastomoses combined with uterine artery occlusion is a safe, feasible surgical procedure in women with symptomatic fibroids. Combining the uterine artery occlusion and blockage of UO anastomoses may be a useful procedure for the decreasing rate of clinical failure and recurrence. This premise should be confirmed in a larger prospective multicenter study.
Holub
Zdenek
Z
Department of Obstetrics and Gynecology, Endoscopic Training Centre, Baby Friendly Hospital, Vancurova 1548, 272 58 Kladno, Czech Republic. holubz@seznam.cz
Jabor
Antonin
A
Hendl
Jan
J
Lukac
Jan
J
Kliment
Lev
L
Urbanek
Stepan
S
D000328:Adult; D016063:Blood Loss, Surgical; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000628:therapy*; D014594:Uterine Neoplasms / Q000628:therapy*; D014599:Uterus / Q000098:blood supply*