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Open Access
CC BY 4.0 · Rev Bras Ginecol Obstet 2020; 42(08): 476-485
DOI: 10.1055/s-0040-1713915
Original Article
Surgery/Endoscopy

Factors Associated with the Complications of Hysteroscopic Myomectomy

Fatores associados às complicações da miomectomia por histeroscopia
Mariana Patelli Juliani de Souza Lima 
1   Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
,
Lúcia Costa-Paiva 
1   Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
,
Luiz Gustavo Oliveira Brito 
1   Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
,
Luiz Francisco Baccaro 
1   Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
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Abstract

Objective To evaluate the factors associated with complete myomectomy in a single surgical procedure and the aspects related to the early complications.

Methods A cross-sectional study with women with submucous myomas. The dependent variables were the complete myomectomy performed in a single hysteroscopic procedure, and the presence of early complications related to the procedure.

Results We identified 338 women who underwent hysteroscopic myomectomy. In 89.05% of the cases, there was a single fibroid to be treated. According to the classification of the International Federation of Gynecology and Obstetrics (Fédération Internationale de Gynécologie et d'Obstétrique, FIGO, in French), most fibroids were of grade 0 (66.96%), followed by grade 1 (20.54%), and grade 2 (12.50%). The myomectomies were complete in 63.31% of the cases, and the factors independently associated with complete myomectomy were the diameter of the largest fibroid (prevalence ratio [PR]: 0.97; 95% confidence interval [95%CI]: 0.96–0.98) and the classification 0 of the fibroid according to the FIGO (PR: 2.04; 95%CI: 1.18–3.52). We observed early complications in 13.01% of the hysteroscopic procedures (4.44% presented excessive bleeding during the procedure, 4.14%, uterine perforation, 2.66%, false route, 1.78%, fluid overload, 0.59%, exploratory laparotomy, and 0.3%, postoperative infection). The only independent factor associated with the occurrence of early complications was incomplete myomectomy (PR: 2.77; 95%CI: 1.43–5.38).

Conclusions Our results show that hysteroscopic myomectomy may result in up to 13% of complications, and the chance of complete resection is greater in small and completely intracavitary fibroids; women with larger fibroids and with a high degree of myometrial penetration have a greater chance of developing complications from hysteroscopic myomectomy.

Resumo

Objetivo Avaliar os fatores associados a miomectomia por histeroscopia completa em um único procedimento e as suas complicações.

Métodos Estudo de corte transversal com mulheres submetidas a histeroscopia para exérese de miomas submucosos. As variáveis dependentes foram a miomectomia completa realizada em um tempo cirúrgico único, e a presença de complicações precoces relacionadas ao procedimento.

Resultados Analisamos 338 mulheres que foram submetidas a miomectomia histeroscópica. Em 89,05% dos casos, o mioma a ser tratado era único. Quanto à classificação da Federação Internacional de Ginecologia e Obstetrícia (Fédération Internationale de Gynécologie et d'Obstétrique, FIGO, em francês), a maioria era de grau 0 (66,96%), seguidos pelos graus 1 (20,54%) e 2 (12,50%). As miomectomias foram completas em 63,31% das mulheres, sendo que os fatores independentemente associados à miomectomia completa foram o diâmetro do maior mioma (razão de prevalência [RP]: 0,97; intervalo de confiança de 95% [IC95%]: 0,96–0,98) e a classificação FIGO grau 0 (RP: 2,04; IC95%: 1,18–3,52). Foram observadas complicações precoces em 13,01% dos procedimentos (4,44% apresentaram sangramento excessivo durante o procedimento, 4,14%, perfuração uterina, 2,66%, falso pertuito, 1,78%, intoxicação hídrica, 0,59%, laparotomia exploradora, e 0,3%, infecção pós-operatória). O único fator independentemente associado à ocorrência de complicações precoces foi a realização de miomectomia incompleta (RP: 2,77; IC95%: 1,43–5,38).

Conclusão Nossos resultados mostram que as complicações da miomectomia por histeroscopia podem ocorrer em até 13% dos procedimentos. A chance de ressecção completa é maior em miomas pequenos e completamente intracavitários; mulheres com miomas maiores e com maior grau de penetração miometrial têm maiores chances de desenvolver complicações.

Keywords

uterine myomectomy - leiomyoma - myoma - uterine hemorrhage - intraoperative complications

Palavras-chave

miomectomia uterina - leiomioma - mioma - hemorragia uterina - complicações intraoperatórias

Contributors

All of the authors contributed with the project and data interpretation, the writing of the article, the critical review of the intellectual content, and with the final approval of the version to be published.




Publication History

Received: 12 December 2019

Accepted: 28 May 2020

Article published online:
08 September 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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