Comparison of Laparoscopic Myomectomy in Large Myomas With and Without Leuprolide Acetate

Objective: To evaluate the efficacy of gonadotropin-releasing hormone analogue (GnRHa) use before laparoscopic myomectomy (LM) in large myomas. Design: Prospective study (Canadian Task Force classification II-1). Setting: University-affiliated hospital. Patients: Ninety-one women with large myomas (≥10 cm) or more than 2 myomas ≥ 5 cm underwent LM between July 2011 and March 2014. Interventions: Forty patients underwent LM after GnRHa use (group A) and 51 underwent LM only (group B). GnRHa was used for 3 doses every 4 weeks before LM in group A. Measurements and Main Results: Group A had a significantly smaller maximum diameter of the largest myoma than group B (8.5 ± 2.1 vs 10.7 ± 2.4, p <.001) and fewer patients with myomas larger than 10 cm after GnRHa administration (33% vs 67%, p =.001). In group A, there was a decrease in 2 or more myomas ≥ 5 cm (20% vs 50%) after GnRHa use. Group A also had significantly smaller mean myoma weight (448 vs 567 g, p =.045) and significantly shorter mean operative time (129 ± 30 vs 152 ± 34 minutes, p =.001). Most patients in group A (40%) had an operative time < 119 minutes, whereas most patients in group B (37%) had an operative time between 150 and 179 minutes. Group A also had less intraoperative blood loss (84 ± 53 vs 137 ± 166 mL, p <.001), drop in hemoglobin (1.5 ± 0.8 vs 3.0 ± 1.7 g/dl, p <.001), excessive bleeding (5% vs 33%, p =.001), postoperative hematoma (2.5% vs 9.8%, p =.168), and blood transfusion (7.5% vs 35%, p =.001). Conclusion: GnRHa before LM in large myomas may be an effective adjuvant treatment for women with large and multiple myomas. This method is beneficial in decreasing operative time, intraoperative bleeding, postoperative hemorrhage, and need of blood transfusion.