Noam Smorgick

Purpose: To quantify obstetric outcomes after prior myomectomy in a tertiary center and to explore whether operative and clinical characteristics are associated with uterine rupture. Methods: Single-center retrospective cohort of deliveries following laparotomic or laparoscopic myomectomy between August 2015 and January 2023. We extracted demographic, surgical, and obstetric data from electronic records, and analyzed only the first consecutive post-myomectomy pregnancy per patient. Results: Sixty-three women delivered after prior myomectomy. 75.5% underwent laparotomic myomectomy and the remainder laparoscopic. The mean largest myoma diameter was 9.6 ± 3.4 cm; 66.7% were intramural. Uterine cavity entry occurred in 30.4%. Trial of labor after myomectomy was attempted in four patients (6.3%) and was successful in three. Two patients had placenta accreta spectrum (3.2%), and two required transfusions for postpartum hemorrhage. One full-thickness uterine rupture was identified incidentally at a planned elective cesarean at 37.4 weeks (1/63; 1.6%) in an asymptomatic patient not in labor. A short myomectomy-to-pregnancy interval showed an association with rupture: < 3 months (OR 103.0, 95% CI 2.85–3728.2; p = 0.007) and < 6 months (OR 25.9, 95% CI 1.94–716.8; p = 0.037). No other variables reached statistical significance, although the analysis was underpowered to assess additional predictors. Conclusion: Uterine rupture after myomectomy was rare (1.6%) in our cohort and was associated with a short myomectomy-to-pregnancy interval. However, as this association is based on a single event, it should be interpreted with caution and considered hypothesis-generating. Despite the low absolute risk, and consistent with literature supporting TOLAM in selected patients, TOLAM was markedly underutilized in our center, highlighting a practice gap that may be addressed through more standardized counseling and delivery planning in tertiary settings.

A prospective trial comparing the effect of preoperative information given verbally with the use of an explanatory animated video before outpatient hysteroscopy on patients’ anxiety and pain - Facts, Views and Vision in ObGyn

Purpose Recurrence of adnexal torsion involving otherwise normal adnexa is not rare. Various oophoropexy (ovarian fixation) procedures have been suggested to prevent recurrence; however, long-term information of their efficacy is lacking. The aim of this study was to investigate the recurrence rate of adnexal torsion following oophoropexy. Methods Retrospective cohort study, including all consecutive patients who underwent an oophoropexy procedure for the prevention of recurrent torsion of “normal adnexa” in our department from 2008 to 2019 by shortening of the utero-ovarian ligament. Results Nineteen patients (age range 7–35 years) with a mean follow-up of 90.9 ± 57.7 months were identified. Fifteen of them (78.9%) were re-operated for recurrent torsion following an oophoropexy procedure, while four (21.1%) did not experience recurrence. Nine torsion recurrences following an oophoropexy occurred within the first 2 postoperative years. There were no differences in mean age and menarcheal status )pre- or post-menarcheal) at the time of the first torsion event, age at the time of oophoropexy, oophoropexy side, number of adnexal torsion events before oophoropexy, and follow-up duration between those with and those without post-oophoropexy recurrences. Conclusion Oophoropexy procedure by shortening of the utero-ovarian ligament may not prevent recurrent torsion of otherwise normal adnexa. Further studies to determine whether combined fixation (utero-ovarian and round ligament plication) is more efficacious than isolated utero-ovarian plication for the prevention of recurrent torsion are warranted.

Background: Laparoscopic removal of ovarian dermoid cysts has been associated with increased risk for recurrence. Objectives: To investigate the risk factors associated with recurrence of dermoid cysts. Methods: We conducted a retrospective review of all women who underwent cystectomy for ovarian dermoid cysts by laparoscopy or laparotomy. At discharge, patients were instructed to undergo a yearly ultrasound exam. A follow-up telephone call was conducted to assess whether an additional surgery for dermoid cysts was required and whether ultrasound recurrence of dermoid cysts was suspected. Results: The study cohort included 102 participants (92 [90.2%] operated by laparoscopy and 10 [9.8%] by laparotomy). The mean follow-up from the index surgery to the interview was 72.1 +/- 38.2 months. The rates of recurrent surgery were similar among women who underwent laparoscopic cystectomy compared with laparotomy (5/92 [5.4%] vs. 1/10 [10.0%], respectively; P = 0.5), while the rates of reported ultrasound recurrence were significantly lower in the laparoscopy group compared with the laparotomy group (10/102 [10.9%] vs. 4/10 [40.0%], respectively; P = 0.03). Additional factors including age, cyst diameter, diagnosis of torsion, intraoperative cyst spillage, estimated blood toss, intraperitoneal adhesions, and postoperative fever were not associated with recurrence. Conclusions: Ultrasound recurrence of dermoid cysts is not uncommon and could be associated with the surgical approach.