The Perinatal Outcomes After Laparoscopic Myomectomy Versus Transabdominal Myomectomy: A Meta-analysis

Objective:To systematically review the perinatal outcomes after laparoscopic myomectomy versus transabdominal myomectomy.Methods:PubMed,Web of Science,Elsevier,The Cochrane Library,CNKI,VIP and WanFang Data databases were searched from inception to July 2019,to collect randomized controlled trials or cohort studies comparing the perinatal outcomes after laparoscopic myomectomy and transabdominal myomectomy.Two reviewers independently screened literature,extracted data and assessed the risk of bias of include studies.Meta-analysis was then performed by RevMan 5.3 software.Results:Eight randomized controlled trials,twenty-one cohort studies involving 4357 patients were included.The results of meta-analysis showed that: the premature birth rate(OR=0.60,95%CI 0.38 to 0.95,P=0.03)in the laparoscopic myomectomy was lower than that in the laparotomy group.However,the rate of uterine rupture during pregnancy(OR=3.19,95%CI 1.29 to 7.89,P=0.01)in the laparoscopic myomectomy was higher than that in the laparotomy group.There were no significant differences between two groups in the myoma residual(OR=1.00,95%CI 0.37 to 2.65,P=0.99),recurrence(OR=0.92,95%CI 0.68 to 1.25,P=0.60),abortion(OR=0.90,95%CI 0.63 to 1.28,P=0.56),ectopic pregnancy(OR=1.11,95%CI 0.54 to 2.26,P=0.78),pregnancy rate(OR=1.06,95%CI 0.89 to 1.27,P=0.52),cesarean(OR=0.82,95%CI 0.57 to 1.19,P=0.31),and pregnancy complications(OR=0.84,95%CI 0.45 to 1.59,P=0.60).Conclusion:Current evidence shows that there are no significant differences between two groups in the myoma residual,myoma recurrence,abortion,ectopic pregnancy,pregnancy rate,cesarean and pregnancy complications.While the rate of uterine rupture during pregnancy in the laparoscopic myomectomy is higher than that in the laparotomy group,the premature birth rate after operation in the laparoscopic myomectomy is lower and shorter than that in the laparotomy group.Due to the limited quantity and quality of the included studies,more high quality studies are required to verify the above conclusion.