Laparoscopic versus open abdominal myomectomy for uterine fibroid management: A systematic review and meta-analysis

Abstract

Background: Uterine fibroids are the most common benign tumors of the female reproductive tract, and laparoscopic myomectomy has emerged as a leading minimally invasive surgical approach. This systematic review and meta-analysis evaluated the efficacy, safety, and reproductive outcomes of laparoscopic myomectomy compared to open abdominal myomectomy in the management of uterine fibroids. Methods: Following the PRISMA 2020 guidelines, a comprehensive search of PubMed, Cochrane Library, Embase, Scopus, and Web of Science databases was conducted for studies published between January 2010 and December 2024. Randomized controlled trials and comparative cohort studies involving women of reproductive age who underwent either laparoscopic or open myomectomy were included. Data were synthesized using meta-analytic techniques with random-effects models. Results: A total of 18 studies comprising 2, 764 patients were included. Laparoscopic myomectomy demonstrated significantly lower intraoperative blood loss (MD = ?34.43 mL; 95% CI: ?34.92 to ?33.94; p<0.001), shorter hospital stay (MD = ?2.82 days; p<0.001), fewer postoperative complications (OR = 0.42; 95% CI: 0.24-0.71; p = 0.001), and reduced postoperative pain scores. However, operative time was significantly longer (MD = 12.96 min; p<0.001). No significant differences were found in pregnancy rates or fibroid recurrence. Conclusion: Laparoscopic myomectomy is a safe and effective alternative to open myomectomy, offering superior perioperative outcomes with comparable fertility and recurrence profiles.