Comparing Surgical Outcomes of Laparoscopic Myomectomy Versus Laparotomy at a Specialized Tertiary Hospital for Women's Health: A Retrospective Study.

backgroundUterine fibroids, which are benign tumors, are the most frequent tumors in women of reproductive age. Although myomectomy, the surgical removal of fibroids, is the most suitable option from the perspective of preserving the patient's reproductive potential, there is not enough real-world research known in Saudi Arabia on which of the two surgical techniques, laparoscopic or open (abdominal) myomectomy.

aimTo assess and compare surgical outcomes, such as intraoperative blood loss, duration of hospital stays, postoperative complications, and duration of surgery, of laparoscopic myomectomy to open abdominal myomectomy (laparotomy) for women suffering from fibroids at the only specialized tertiary women's hospital in Saudi Arabia.  Methods: This real-world retrospective study analyzes 299 women who underwent myomectomy from January 2021 to October 2025. Participants were grouped according to laparoscopic (n = 88) and open (n = 211) myomectomy. Women diagnosed with uterine fibroids, women aged 18 to 45, and women who underwent either laparoscopic or open myomectomy were included in the study. This study excluded patients with missing or incomplete data, patients with suspected malignant uterine tumors, and postmenopausal women. Comparisons of demographics and surgical outcomes were performed with the Mann-Whitney U test, independent t-test, and chi-square and Fisher's exact tests, as appropriate. Effect sizes were calculated using the rank-biserial correlation coefficient with bootstrap 95% confidence intervals (10,000 iterations). Age, body mass index, fibroid size, and fibroid multiplicity were adjusted for in the evaluation of the independent association between surgical approach and outcomes. Body mass index and fibroid count were the criteria for pre-specified subgroup analysis.

resultsThe two groups revealed no statistical differences in age (median 37 vs. 37 years; p = 0.901) and body mass index (median 27.6 vs. 28.5 kg/m²; p = 0.625). Patients undergoing laparoscopic myomectomy had significantly shorter length of hospital stay (median 3.0 vs. 4.0 days; p < 0.001; rank-biserial r = 0.45); this difference remained after multivariable analysis (β = -0.860; 95% CI: -1.251 to -0.469; p < 0.001). On the contrary, laparoscopic myomectomy had a significantly greater average surgery duration (median 213.0 vs. 121.0 minutes; p < 0.001; rank-biserial r = -0.527; adjusted β = 90.490; 95% CI: 70.029-110.951; p < 0.001). There were no significant differences in estimated blood loss (median 300 vs. 400 mL; p = 0.394), hemoglobin drop (median 13.0 vs. 14.0 g/L; p = 0.948), and overall complications (3.4% vs. 1.4%; p = 0.364). On multivariable logistic regression analysis, laparoscopic myomectomy was not a significant complication predictor (OR = 1.715; 95% CI: 0.283-10.378; p = 0.557). Larger and more numerous fibroids were associated with longer surgery and greater blood loss.

conclusionCompared to open myomectomy, laparoscopic myomectomy has meaningfully shorter hospital stays, with similar rates of blood loss, decline in hemoglobin, and similar rates of postoperative complications. The downside is that laparoscopic myomectomy has a substantially longer operative time. Laparoscopic myomectomy is safe and effective in appropriately selected patients at specialized tertiary care centers. Fibroid size and number, and not the choice of surgical technique, were the main contributors to intraoperative blood loss.