Laparotomy or laparoscopy as surgical treatment of fibroids for subfertility

There might possibly be no difference in fertility efficacy outcome if fibroids are removed via laparotomy when compared to laparoscopy, although the evidence is limited.

A Cochrane review included 1 trial (131 women) and this was probably underpowered. There was no evidence of a difference in clinical pregnancy rate (OR 0.91, 95% CI 0.44 to 1.90) and live birth rate (OR 0.66, 95% CI 0.31to 1.39) when fibroids were removed via laparotomy or laparoscopy for infertility. Shorter hospital stay, less febrile illness and a smaller drop in pre-operative haemoglobin concentration was noticed with laparoscopy compared to laparotomy. There were no randomised controlled studies comparing hysteroscopic removal or no intervention with other surgical modalities.

Comment: The quality of evidence is downgraded by study quality (inadequate allocation concealment), by imprecise results (few outcome events), and by potential reporting bias (one small study).

Ədəbiyyat

1. Griffiths A, D'Angelo A, Amso N. Surgical treatment of fibroids for subfertility. Cochrane Database Syst Rev 2006 Jul 19;3:CD003857.