Laparoscopic Myomectomy Versus Open Myomectomy For Uterine Myomas-A Meta-analysis Of Randomized Controlled Trials

Objective: To determine the efficacy and safety and long term outcome of theremoval of uterine fibroids in women by laparoscopic myomectomy (LM) or openmyomectomy (OM). Methods: We searched PubMed (1966～2012.08), EMbase (1980～2012.08), Ovid(1993～2012.08), Cochrane Library (1996～2012.08), Evidence-BasedMedicine reviews (EBMR1993～2012.8),Chinese biomedical literature database(1980～2012.08),CNKI(1979～2012.08), Wanfang medical network and Chinese science andTechnology Periodical Full-text Database(1978～2012.08). We obtained seven studieswhich were all randomized controlled trials. The Meta-analyses were performed usingRevMan5.1.7software. Results: There are seven randomized controlled trials wereincluded of which328patients were in the LM group and the other328patients were inthe OM group. The results of meta-analysis showed that:1.pregnancy outcomes:Compared with LM and OM had no significant differences in pregnancy rate, miscarriagerate, the rate of cesarean section, vaginal delivery rate and the rate of preterm birth[OR=1.32,95%CI (0.80,2.17), P=0.28];[OR=1.24,95%CI (0.45,3.37), P=0.68];[OR=0.93,95%CI (0.39,2.18), P=0.86];[OR=1.08,95%CI (0.46,2.53), P=0.86];[OR=0.67,95%CI (0.10,4.28), P=0.67].2.complications: overall complications andpostoperative complications in the2groups there are differences[OR=0.50,95%CI (0.28,0.89), P=0.02];[OR=0.46,95%CI (0.25,0.86), P=0.02]. But intraoperative complicationsand the main complications had no significant differences in the2groups[OR=0.99,95%CI (0.25,4.01), P=0.99];[OR=0.49,95%CI (0.09,2.70), P=0.41].3. recurrence rate:between2groups had no differences [OR=1.15,95%CI (0.60,2.18), P=0.67].4.Operation time: it was found to be significantly longer in the LM group [OR=12.02,95% CI (8.45,15.59), P＜0.00001];5.The time of postoperative ileus was significantly shorterin the LM group compared with the OM group [OR=－15.14,95%CI (－19.05,－11.23),P＜0.00001].6.Mean blood loss and mean hemoglobin level decrease were significantlylower in the LM compared with the OM group [OR=－47.20,95%CI (－60.79,－33.61),P＜0.00001];[OR=－1.04,95%CI (－1.14,－0.93),P＜0.00001]. Conclusion:Laparoscopic and open myomectomy are all safe and feasible. The overall complicationsand the postoperative complications are fewer. Mean blood loss and mean hemoglobinlevel decrease were significantly lower in the LM compared with the OM group.Operation time was significantly longer in the LM group, but the time of postoperativeileus was significantly shorter. Compare with intraoperative complications and the maincomplications, pregnancy outcome and recurrence had no difference. We favor LM ifperformed by suitably specialized surgeons in selected patients. We need More highquality studies to provide important data of comparison between LM and OM.