Surgical Outcomes and Risk Factors for Laparoconversion and Adhesion Formation Following Laparoscopic Myomectomy in Cameroonian Women
Résultats Chirurgicaux et Facteurs de Risque de Laparoconversion et d'Adhérences Après Myomectomie par Laparoscopie Chez la Femme Camerounaise
DOI:
https://doi.org/10.5281/zenodo.18280555Keywords:
Laparoscopic Myomectomy, Uterine Fibroids, Laparoconversion, Pelvic Adhesions, Cameroon.Abstract
ABSTRACT
Introduction. Laparoscopic myomectomy (LM) is a standard fertility-preserving surgery for uterine fibroids in high-resource settings. Its adoption and outcomes in sub-Saharan Africa, where fibroid prevalence is high but advanced laparoscopy access is limited, remain underexplored. This study assesses the feasibility, safety, and predictors of adverse outcomes of LM in Cameroon. Methods. A mixed-methods cohort study was conducted at two tertiary hospitals in Yaoundé from January 2019 to September 2023. Forty-seven patients undergoing LM (including conversions) were included. Data on demographics, fibroid characteristics, and operative details were collected. Primary outcomes were laparoconversion rate and adhesion prevalence on second-look laparoscopy. Multivariate logistic regression identified independent predictors. Results. LM constituted 11.86% of all myomectomies. Patients were young (mean age 33.3±4.8 years), primarily nulliparous, with fertility desire as the main indication (87.2%). The laparoconversion rate was 8.5%. Multivariate analysis identified largest fibroid size ≥7 cm (aOR 16.85, 95% CI 2.05–138.42) and operative time ≥120 minutes (aOR 12.75, 95% CI 1.60–101.56) as independent predictors of conversion. The postoperative adhesion rate was low (19.4%). Independent risk factors for adhesions were largest fibroid size ≥7 cm (aOR 12.6, 95% CI 2.1–74.8), anterior location (aOR 5.9, 95% CI 1.1–32.4), and laparoconversion (aOR 18.7, 95% CI 2.6–135.9). Conclusion. LM is feasible and safe in this Cameroonian setting, with low morbidity and adhesion rates. However, large fibroids significantly increase the risk of both conversion and adhesions. Anterior location specifically elevates adhesion risk, while prolonged surgery signals high conversion risk. These findings emphasize meticulous preoperative selection and real-time surgical decision-making to optimize fertility outcomes in resource-constrained environments.
RÉSUMÉ
Introduction. La myomectomie laparoscopique (ML) est le traitement de référence des fibromes utérins chez les femmes désireuses de préserver leur fertilité. Son adoption et ses résultats en Afrique subsaharienne, où la prévalence des fibromes est élevée mais l'accès à la chirurgie avancée limité, restent mal documentés. Cette étude évalue la faisabilité, la sécurité et les déterminants des résultats de la ML au Cameroun. Méthodologie. Une étude de cohorte mixte a été menée dans deux hôpitaux tertiaires de Yaoundé de janvier 2019 à septembre 2023. Quarante-sept patientes ayant subi une ML (y compris les conversions) ont été incluses. Les données démographiques, les caractéristiques des fibromes et les détails opératoires ont été collectés. Les critères de jugement principaux étaient le taux de laparoconversion et la prévalence des adhérences lors d'une cœlioscopie de contrôle. Une régression logistique multivariée a identifié les prédicteurs indépendants. Résultats. La ML représentait 11,9% de toutes les myomectomies. Les patientes étaient jeunes (âge moyen 33,3 ± 4,8 ans), principalement nullipares, avec un désir de grossesse comme indication principale (87,2%). Le taux de conversion était de 8,5%. L'analyse multivariée a identifié une taille du plus gros fibrome ≥7 cm (ORa 16,85 ; IC95% 2,05–138,42) et un temps opératoire ≥120 minutes (ORa 12,75 ; IC95% 1,60–101,56) comme prédicteurs indépendants de conversion. Le taux d’adhérences postopératoires était faible (19,4%). Les facteurs de risque indépendants pour les adhérences étaient une taille de fibrome ≥7 cm (ORa 12,6 ; IC95% 2,1–74,8), une localisation antérieure (ORa 5,9 ; IC95% 1,1–32,4) et la laparoconversion (ORa 18,7 ; IC95% 2,6–135,9). Conclusion. La ML est faisable et sûre en contexte camerounais, avec une faible morbidité et un faible taux d'adhérences. Cependant, les fibromes de grande taille augmentent significativement les risques de conversion et d'adhérences. La localisation antérieure augmente spécifiquement le risque d'adhérences, tandis qu'une durée opératoire prolongée signale un risque élevé de conversion. Une sélection préopératoire rigoureuse est essentielle pour optimiser les résultats de fertilité.
References
1. Stewart EA, Cookson CL, Gandolfo RA, Schulze-Rath R. Epidemiology of uterine fibroids: a systematic review. BJOG. 2017 ; 124(10):1501-1512. doi: 10.1111/1471-0528.14640.
2. Bulun SE. Uterine fibroids. N Engl J Med. 2013 Oct 3;369(14):1344-55. doi: 10.1056/NEJMra1209993.
3. Semm K. New methods of pelviscopy (gynecologic laparoscopy) for myomectomy, ovariectomy, tubectomy and adnectomy. Endoscopy. 1979 ; 11(2):85-93. doi: 10.1055/s-0028-1098329.
4. Alessandri F, Lijoi D, Mistrangelo E, Ferrero S, Ragni N. Randomized study of laparoscopic versus minilaparotomic myomectomy for uterine myomas. J Minim Invasive Gynecol. 2006 ;13(2):92-7. doi:10.1016/j.jmig.2005.11.008.
5. Dubuisson JB, Fauconnier A, Babaki-Fard K, Chapron C. Laparoscopic myomectomy: a current view. Hum Reprod Update. 2000 ;6(6):588-94. doi: 10.1093/humupd/6.6.588.
6. Afuwape OO, Akute OO. The challenges and solutions of laparoscopic surgical practice in the developing countries. Niger Postgrad Med J. 2011 ;18(3):197-9.
7. Cyrille, N., Etienne, B., Festus, W., Fulbert, M. and Marie, K. (2019) Laparoscopic versus Abdominal Myomectomy: Surgical and Post-Operative Outcomes in CHRACERH Yaounde. Open Journal of Obstetrics and Gynecology. 2019 ; 9 : 1595-1603. doi: 10.4236/ojog.2019.912155.
8. Bhave Chittawar P, Franik S, Pouwer AW, Farquhar C. Minimally invasive surgical techniques versus open myomectomy for uterine fibroids. Cochrane Database Syst Rev. 2014 ; 2014(10):CD004638. doi: 10.1002/14651858.CD004638.pub3.
9. Pitter MC, Gargiulo AR, Bonaventura LM, Lehman JS, Srouji SS. Pregnancy outcomes following robot-assisted myomectomy. Hum Reprod. 2013 ; 28(1):99-108. doi: 10.1093/humrep/des365.
10. Tinelli A, Mettler L, Malvasi A, Hurst B, Catherino W, Mynbaev OA, Guido M, Alkatout I, Schollmeyer T. Impact of surgical approach on blood loss during intracapsular myomectomy. Minim Invasive Ther Allied Technol. 2014; 23(2):87-95. doi: 10.3109/13645706.2013.839951.
11. Lethaby A, Puscasiu L, Vollenhoven B. Preoperative medical therapy before surgery for uterine fibroids. Cochrane Database Syst Rev. 2025 ;4:CD000547. doi: 10.1002/14651858.CD000547.pub3.
12. Jin C, Hu Y, Chen XC, Zheng FY, Lin F, Zhou K, Chen FD, Gu HZ. Laparoscopic versus open myomectomy--a meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol. 2009 ; 145(1):14-21. doi: 10.1016/j.ejogrb.2009.03.009.
13. Sizzi O, Rossetti A, Malzoni M, Minelli L, La Grotta F, Soranna L, Panunzi S, Spagnolo R, Imperato F, Landi S, Fiaccamento A, Stola E. Italian multicenter study on complications of laparoscopic myomectomy. J Minim Invasive Gynecol. 2007 ; 14(4):453-62. doi: 10.1016/j.jmig.2007.01.013.
14. Dubuisson JB, Fauconnier A, Fourchotte V, Babaki-Fard K, Coste J, Chapron C. Laparoscopic myomectomy: predicting the risk of conversion to an open procedure. Hum Reprod. 2001;16(8):1726‑31. doi:10.1093/humrep/16.8.1726
15. Sinha R, Hegde A, Warty N, Patil N. Laparoscopic excision of very large myomas. J Am Assoc Gynecol Laparosc. 2003 ; 10(4):461-8. doi: 10.1016/s1074-3804(05)60145-4.
16. Munro MG, Critchley HOD, Broder MS, Fraser IS. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011;113(1):3-13. doi:10.1016/j.ijgo.2010.11.011
17. Iavazzo C, Mamais I, Gkegkes ID. Robotic assisted vs laparoscopic and/or open myomectomy: systematic review and meta-analysis of the clinical evidence. Arch Gynecol Obstet. 2016 ; 294(1):5-17. doi: 10.1007/s00404-016-4061-6.
18. Dueholm M, Lundorf E, Hansen ES, Ledertoug S, Olesen F. Accuracy of magnetic resonance imaging and transvaginal ultrasonography in the diagnosis, mapping, and measurement of uterine myomas. Am J Obstet Gynecol. 2002 ; 186(3):409-15. doi: 10.1067/mob.2002.121725.
19. Tulandi T, Murray C, Guralnick M. Adhesion formation and reproductive outcome after myomectomy and second-look laparoscopy. Obstet Gynecol. 1993 ; 82(2):213-5.
20. Takeuchi H, Kitade M, Kikuchi I, Shimanuki H, Kumakiri J, Kinoshita K. Adhesion-prevention effects of fibrin sealants after laparoscopic myomectomy as determined by second-look laparoscopy: a prospective, randomized, controlled study. J Reprod Med. 2005 ; 50(8):571-7.
21. Ahmad G, O'Flynn H, Hindocha A, Watson A. Barrier agents for adhesion prevention after gynaecological surgery. Cochrane Database Syst Rev. 2015 Apr 30;2015(4):CD000475. doi: 10.1002/14651858.CD000475.pub3. Update in: Cochrane Database Syst Rev. 2020 ; 3:CD000475. doi: 10.1002/14651858.CD000475.pub4.
22. Parker WH, Rodi IA. Patient selection for laparoscopic myomectomy. J Am Assoc Gynecol Laparosc. 1994 ; 2(1):23-6. doi: 10.1016/s1074-3804(05)80826-6.
23. Diamond MP. Reduction of adhesions after uterine myomectomy by Seprafilm membrane (HAL-F): a blinded, prospective, randomized, multicenter clinical study. Seprafilm Adhesion Study Group. Fertil Steril. 1996 ; 66(6):904-10.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Isidore Tompeen, Willy Stéphane Watat Tchatchouang, Junie Metogo, Clovis Ourtching, Kodoume Motolouze, Junie Ngaha, Cliford Ebong, Vanina Ngono Akam, Serge Nyada, Loïc Meukem Tatsipie, Julius Dohbit Sama, Esther Meka Ngo Um, Claude Noa Ndoua
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License CC BY-NC-ND 4.0 that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work
