Abstract No. 86: Retrospective comparative analysis of reintervention rates after laparoscopic myomectomy vs. uterine artery embolization in the treatment of symptomatic uterine fibroids

To compare the incidence of reintervention in patients with symptomatic uterine fibroids who underwent either laparoscopic myomectomy or uterine artery embolization. In this retrospective, IRB-approved study we reviewed the medical records of all women with symptomatic uterine fibroids, who presented to our institution for either uterine artery embolization (UAE) or laparoscopic myomectomy(LM), between January 2006 and February 2010. The patients were divided in two groups according to the procedure performed: UAE and LM groups. The data collected included patients' demographics, diagnosis, indication for procedure, long-term clinical follow-up, viable post-procedural pregnancy, and need for a second procedure (reintervention). Results are given in mean ± SD. Statistical analysis was performed with student's t-test and chi-square with significance considered at p<0.05. A total of 76 women were identified; 65.7% in the UAE group (n=50, age 44.6 ±7.2) and 34.3% in the LM group (n=26, age 41±6.9). There were no differences in patients' demographics in either group. There were no significant statistical differences in the indications for either procedure. Long-term follow-up in the UAE group was 552±409 days as compared to 482 ±411 days in the LM group (p=0.5). The incidence of viable post-procedural pregnancy was 11.5% in the LM (n=3), as compared to 2.4% in the UAE group (n=1), not significant (p =0.0773). The overall incidence of reintervention was 3.8% in the LM group (n=1), lower than in the UAE group(n=5, 10%), but not statistically significant(p=0.3452). In the UAE group, 80% (n=4) of the re-interventions were performed for bulk-related symptoms; and 20% for persistent bleeding (n=1). Reinterventions included hysterectomy (n=4), uterine artery embolization (n=1) and endometrial ablation (n=1). In this retrospective series there were no significant differences in reintervention within 2 years after UAE as compared to LM, with the majority of patients undergoing second procedures because of bulk-related symptoms. Prospective studies are still needed for further comparison of patients' indications and outcomes in fibroid treatment.