Prevalence of Intrauterine Adhesions After Abdominal Myomectomy

Study Overview
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Brief Summary
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Uterine fibroids are the most common benign tumors of the genital organs of women of childbearing age. Literature data show that more than 75% of women have fibroids.Symptomatic fibroids account for approximately over 200,000 hysterectomies and 50,000 myomectomies annually in the United States. Fibroids have a major impact on fertility, with significant adverse effect on implantation rate and spontaneous abortion rates when compared with infertile women without fibroids. The definitive treatment for uterine fibroids in a fertile patient is surgical excision. Although usually effective, myomectomy is not a risk-free operation, since the surgical procedure can cause mechanical infertility and can be associated with infection, injury to adjacent tissues, hemorrhage and need to convert to hysterectomy. A not often mentioned consequence of myomectomy is post-operative intrauterine adhesion formation. It has been reported that 50% of women undergoing open myomectomy are found to have intrauterine adhesions diagnosed by hysteroscopy performed 3 months after surgery. Such a high prevalence of intrauterine adhesions after open myomectomy is unexpected, however only few studies have addressed this topic. It is accepted that injury to the endometrium is generally considered to be the primary causative factor for the development of intrauterine adhesions. The reason for such a high incidence of intrauterine adhesions after open myomectomy is unclear. It is speculated that infection or in adverted closure of the uterine cavity may play a role in intrauterine adhesion formation. The relationship between the number of fibroids removed and the risk of adhesions suggests a traumatic etiology. In the preservation of the uterus for the purpose of fertility, it is essential to also understand the impact of myomectomy on the endometrium. Currently no guideline recommends in office hysteroscopy as follow-up after myomectomy. The purpose of the present study is to evaluate the frequency of uterine adhesions following myomectomy and the impact of number, size and location of the fibroids as well as intraoperative breach of the endometrial cavity at the time of the myomectomy.

Official Title
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Prevalence of Intrauterine Adhesions After Abdominal Myomectomy

Conditions
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Myoma;Uterus

Intervention / Treatment
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* Diagnostic Test: Diagnostic hysteroscopy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of one or more uterine myomas Desire to preserve fertility/uterus Myomectomy (by laparotomy, laparoscopy or robotic approach). Exclusion Criteria: Adults unable to consent Pregnant women Prisoners History of previous intrauterine procedures such as dilation and curettage History of known intrauterine adhesions History of documented pelvic inflammatory disease History of endometritis (acute or chronic) Hysteroscopic myomectomy

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Open (laparotomic) myomectomy<br>Women undergoing uterine myomectomy by open surgery (laparotomy). | Diagnostic Test: Diagnostic hysteroscopy<br>* Diagnostic hysteroscopy performed in outpatient setting, using no touch vaginoscopy technique with a 2.9 mm 30-degree rigid hysteroscope with a single inflow sheet using normal saline as distention media.<br>|
| Laparoscopic myomectomy<br>Women undergoing uterine myomectomy by laparoscopy. | Diagnostic Test: Diagnostic hysteroscopy<br>* Diagnostic hysteroscopy performed in outpatient setting, using no touch vaginoscopy technique with a 2.9 mm 30-degree rigid hysteroscope with a single inflow sheet using normal saline as distention media.<br>|
| Robotic myomectomy<br>Women undergoing uterine myomectomy by robotic surgery. | Diagnostic Test: Diagnostic hysteroscopy<br>* Diagnostic hysteroscopy performed in outpatient setting, using no touch vaginoscopy technique with a 2.9 mm 30-degree rigid hysteroscope with a single inflow sheet using normal saline as distention media.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intrauterine adhesions | Presence of intrauterine adhesion, following the American Fertility Society classification (Fertil Steril. 1988;49:944-955.) in mild, moderate, or severe. | 3 months after myomectomy | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Hysteroscopy, Intrauterine adhesions, Abdominal myomectomy