Risk of uterine rupture after myomectomy by laparoscopy or laparotomy.

Study Objective: Evaluate the shift in surgical trends for myomectomy and subsequent changes in the number of uterine ruptures over the years.

Methods: Retrospective analysis utilizing the HCUP-NIS database. Evaluating women, aged 18-40 years, who underwent myomectomy by laparoscopy or laparotomy, and who subsequently had uterine rupture between 2005 and 2014. Statistical analysis focused on the odds ratio of having uterine rupture after a myomectomy and the trends over the years.

Results: Of a total 54,146 myomectomies, there were 237 uterine ruptures, which stands for 0.43 %. Mean age was 31.8 years, mainly Caucasians and had private insurance. The procedure was performed mainly by laparotomy with 97.7 %, and 2.3 % were performed by laparoscopy. There was a decrease of total myomectomies from 6646 in 2005-4589 in 2014. The numbers of uterine rupture per 1,000 myomectomies were 4.2 after laparotomy and 10.6 after laparoscopic approach.

Conclusion: The myomectomy trend changed in recent years with a greater predominance of laparotomies over laparoscopies. Laparoscopic myomectomy may by itself increase the risk for uterine rupture compared to open approach.