Abstract
OBJECTIVE: To evaluate the effects of pelvic drainage and postoperative rectal misoprostol on short-term outcomes after laparoscopic myomectomy. DESIGN: Multicenter retrospective observational cohort study. SETTING: Five tertiary hospitals in Sichuan Province, China, between January 2021 and June 2025. PATIENTS: Of 302 patients initially identified, 280 met inclusion criteria after exclusions for malignancy, incomplete data, or combined procedures. INTERVENTIONS: Patients were categorized into four groups according to surgical approach (multi-port vs. single-port) and postoperative management strategy, allowing evaluation of the independent effects of pelvic drainage and misoprostol within different surgical contexts. The use of pelvic drainage and rectal misoprostol (400 μg) was non-randomized and determined by institutional protocol and surgeon discretion. Perioperative parameters-including operative time, blood loss, drainage characteristics, and postoperative recovery-were extracted from electronic medical records. MAIN OUTCOME MEASURES: The primary outcomes were postoperative fever and pelvic infection; secondary outcomes included drainage output and duration, postoperative pain, and length of hospital stay. RESULTS: Pelvic drainage did not reduce postoperative fever or pelvic infection. In multivariable logistic regression adjusted for relevant covariates (including age, BMI, parity, prior abdominal surgery, myoma size, number of myomas removed, and use of vasopressin or other hemostatic agents), drain placement independently increased the risk of postoperative fever (adjusted OR = 2.30, 95% CI 1.10-4.82, p = 0.028). In contrast, postoperative rectal administration of misoprostol significantly decreased the risk of postoperative fever (adjusted OR = 0.53, 95% CI 0.30-0.96, p = 0.031) and pelvic infection (adjusted OR = 0.36, 95% CI 0.12-0.97, p = 0.043). Among patients with drainage, misoprostol use further reduced total drain volume and duration (both p < 0.05). Patients undergoing single-port procedures without drainage also showed low complication rates, with less postoperative pain and shorter hospital stays compared with multi-port cases with drains (all p < 0.05). CONCLUSION: Pelvic drainage after laparoscopic myomectomy offers no measurable benefit and may heighten postoperative morbidity. In contrast, adjunctive rectal misoprostol effectively lowers the incidence of postoperative fever and pelvic infection.