Objective: To evaluate factors contributing to uterine scar formation after laparoscopic myomectomy (LM) and to estimate whether uterine scarring indicated risk of uterine rupture.
Design: Retrospective study.
Setting: University-affiliated hospital.
Population: A total of 692 patients who underwent second-look laparoscopy (SLL) after LM.
Method: Video-tape recording during SLL to evaluate the conditions of uterine suture wound healing, with univariate and logistic regression analysis.
Main outcome measures: Correlation between scar formation and operative findings at LM. Factors influencing scar formation in 305 patients with an enucleated solitary myoma.
Results: SLL revealed that 628 patients (90.8%) had a normal uterus and 64 patients (9.2%) had a scarred uterus. Deformation of the endometrium found by preoperative imaging and complete myometrial penetration during LM had a positive correlation and the number of enucleated myomas a negative correlation with scar formation. Significant factors associated with scar formation were complete myometrial penetration (odds ratio, 2.53; 95% confidence interval, 1.30-4.93; p = 0.006) and enucleation of a subserosal myoma (odds ratio, 0.23; 95% confidence interval, 0.08-0.70; p = 0.009). Of the 98 patients who delivered, none suffered a uterine rupture regardless of the presence of a uterine scar.
Conclusions: Uterine scar formation after LM correlated with the degree of myometrial penetration. However, the presence of a uterine scar did not appear to influence the delivery outcome.