The effects and costs of laparoscopic versus abdominal myomectomy in patients with uterine fibroids: a systematic review and meta-analysis

BACKGROUND: Abdominal myomectomy (AM) and laparoscopic myomectomy (LM) are commonly see surgery for the uterine fibroids, several randomized controlled trials (RCTs) have compared the role of AM and LM, the results remained inconsistent. Therefore, we attempted this meta-analysis to analyze the role of LM versus AM in patients with uterine fibroids. METHODS: We searched PubMed et al. databases from inception date to July 31, 2019 for RCTs that compared LM versus AM in patients with uterine fibroids. Two authors independently screened the studies and extracted data from the published articles. Summary odd ratios(OR) or mean differences(MD) with 95% confidence intervals(CI) were calculated for each outcome by means of fixed- or random-effects model. RESULTS: Twelve RCTs with a total of 1783 patients were identified, with 887 patients for and 897 patients for AM. Compared with AM, LM could significantly decrease the blood loss (OR = − 29.78, 95% CI -57.62– − 0.95), shorten the duration of postoperative ileus (OR = − 10.91, 95% CI -18.72– − 3.11), reduce the length of hospital stay (OR = − 1.57, 95% CI -2.05– − 1.08), but LM was associated with longer duration of operation (OR = 16.10, 95% CI 6.52–25.67) and higher medical cost (OR = 17.61, 95% CI 7.34–27.88). CONCLUSIONS: LM seems to be a better choice for patients with uterine fibroids, more related studies are needed to identify the role of LM and AM for the treatment of uterine fibroids.