Abstract
Uterine fibroids are the most common benign tumors of the uterus, affecting millions of women worldwide. Laparoscopic myomectomy (LM) and open myomectomy (OM) are the two most common surgical modalities for treating uterine fibroids, particularly in women wishing to preserve their uterus. This systematic review and meta-analysis aims to compare intraoperative, postoperative, and obstetric outcomes of LM and OM in women with uterine fibroids. Adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive literature search was performed using PubMed, Embase, Web of Science, Scopus, Cochrane, Ovid platform, and Google Scholar. Data analysis was conducted using an Excel spreadsheet, and meta-analysis was performed on Review Manager (RevMan) version 5.4.1 (The Cochrane Collaboration, London, UK). Results were presented in the form of mean and standard deviation (SD), standardized mean difference (SMD), 95% confidence interval (CI), and risk ratio (RR). Heterogeneity (I²) was considered significant when it exceeded 50%. For the quality assessment of the risk of bias, ROBINS-I and RoB 2 tools were used. GRADEpro was used to generate the summary of findings tables for primary and secondary outcomes. Analysis was conducted on 14 published studies, comprising 12 non-randomized trials, mainly retrospective, and 2 randomized trials. The review included studies from 12 different countries, spanning from 2000 to 2024, involving a total of 3,828 women with uterine fibroids (1,879 LM, 1,949 OM). The age of participants ranged from 18 to 50 years (mean age: LM, 39.82 ± 4.02; OM, 35.61 ± 3.83). Key findings indicated that LM resulted in significantly less blood loss than OM (SMD 1.21), shorter hospital stay (SMD 1.76), and less postoperative hemoglobin drop (SMD 1.44). However, LM had a longer duration of surgery (MD = 12.29 minutes, P = 0.20). Both the number and size of myomas removed are slightly lower in LM compared to OM, with statistically significant differences (P < 0.0001); however, high heterogeneity across studies suggests notable variability in outcomes. Obstetric outcomes favored LM with a higher pregnancy rate (29.30% vs. 22.40%, P = 0.01) and a higher rate of normal vaginal delivery (37.90% vs. 32.10%, P = 0.27), and a lower caesarean section rate (47.40% vs. 57.80%, P = 0.17) among women who conceived post-myomectomy as compared to OM. No significant difference was observed in miscarriage rates (13.50% vs. 14.10%, P = 0.90) between the two groups. In conclusion, LM offers significant advantages in reducing intraoperative and postoperative morbidity compared to the traditional open approach. However, determining the superior approach in terms of minimizing complications and improving obstetric and long-term fertility outcomes remains a subject of ongoing debate. The choice of procedure depends on surgical expertise and patient-specific factors: number of fibroids, site, and size of fibroids. The laparoscopic approach for multiple myomas is still controversial, while open myomectomy appears more suitable for multiple and large-sized fibroids.