title: Intrauterine synechiae after myomectomy; laparotomy versus laparoscopy: Non-randomized interventional trial.
abstract: BACKGROUND
  Leiomyomata is the most frequent gynecological neoplasm. One of the major complications of myomectomy is intrauterine adhesion (synechiae).
  
  
  OBJECTIVE
  To evaluate and compare the rate and severity of synechiae formation after myomectomy by laparotomy and laparoscopy.
  
  
  METHODS
  In this non-randomized interventional trial, hysteroscopy was performed in all married fertile women who had undergone myomectomy (type 3-6 interamural and subserosal fibroids) via laparotomy and laparoscopy in Tehran's Arash Hospital from 2010 to 2013. Three months after the operation, the occurrence rate and severity of intrauterine synechiae, and its relationship with type, number and location of myomas were investigated and compared in both groups.
  
  
  RESULTS
  Forty patients (19 laparoscopy and 21 laparotomy cases) were studied. Both groups were similar regarding the size, type (subserosal or intramural), number and location of myoma. The occurrence rate of synechiae in the laparoscopy and laparotomy group was 21% and 19%, respectively; showing no significant difference (p=0.99). Among all patients, no significant relationship was found between the endometrial opening (p=0.92), location (p=0.14) and type of myoma (p=0.08) with the occurrence rate of synechiae. However, a significant relationship was observed between myoma's size (p=0.01) and the location of the largest myoma with the occurrence of synechiae (p=0.02).
  
  
  CONCLUSIONS
  With favorable suturing methods, the outcome of intrauterine synechiae formation after myomectomy, either performed by laparotomy or laparoscopy, is similar. In all cases of myomectomy in reproductive-aged women, postoperative hysteroscopy is highly recommended to better screen intrauterine synechiae.
authors.affiliation: Department of Gynecologic Laparoscopy, Arash Women's Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Asgari
authors.affiliation: Department of Obstetrics and Gynecology, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Leili
authors.initials: L
authors.lastname: Hafizi
authors.affiliation: Department of Gynecologic Laparoscopy, Arash Women's Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Rayhaneh
authors.initials: R
authors.lastname: Hosseini
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Atiyeh
authors.initials: A
authors.lastname: Javaheri
authors.affiliation: Research Development Center, Arash Women's Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Hathis
authors.initials: H
authors.lastname: Rastad
keywords: Hysteroscopy; Intrauterine synechiae; Laparoscopy; Laparotomy; Uterine myomectomy