Reproductive Outcomes Following Use of Barbed Suture During Laparoscopic Myomectomy

OBJECTIVE: To review pregnancy outcomes after laparoscopic myomectomy with use of barbed suture. DESIGN: A retrospective cohort study and follow up survey. SETTING: Single large academic medical center. PATIENTS: Patients who underwent laparoscopic myomectomy with the use of barbed suture for myometrial closure between 2008 - 2016. INTERVENTION: Laparoscopic myomectomy and a follow up survey regarding pregnancy outcome. MEASUREMENTS AND MAIN RESULTS: A total of 486 patients met inclusion criteria and underwent a laparoscopic myomectomy between 2008 and 2016. Of the 428 with viable contact information, 240 agreed to participate (56%). Of those who responded to the survey, 101 (42%) attempted to get pregnant and there were four unplanned pregnancies. There were 110 pregnancies amongst 76 survey respondents. In total, of the women attempting a post-operative pregnancy, 71% had at least one pregnancy. Comparing the women that did and did not conceive post-operatively, the group who got pregnant was on average younger, 33.8±4.5 years old vs. 37.5±6.5 years (p =.001), had fewer fibroids removed, 2.6±1.9 vs. 3.7±3.5 fibroids (p= .038) and had a longer follow up period, 54±24 months vs. 34±20 (p \u3c.001). The mean time to first postoperative pregnancy was 18.0 months (range 2-72 months). Of the 110 reported postoperative pregnancies there were 60 live births (55%), 90% via cesarean section. The mean gestational age at birth was 37.8 weeks. In the cohort there were eight preterm births, three cases of abnormal placentation, two cases of fetal growth restriction, three cases of hypertensive disorders of pregnancy and two of fibroid degenerations requiring hospitalization for pain control. There were no uterine ruptures reported. CONCLUSION: According to our findings, pregnancy outcomes after laparoscopic myomectomy with barbed suture are comparable to available literature of pregnancy outcomes with conventional smooth suture