Risk of uterine rupture after myomectomy by laparoscopy or laparotomy

Evaluate the shift in surgical trends for myomectomy and subsequent changes in the number of uterine ruptures over the years. Retrospective analysis utilizing the HCUP-NIS database. Evaluating women, aged 18–40 years, who underwent myomectomy by laparoscopy or laparotomy, and who subsequently had uterine rupture between 2005 and 2014. Statistical analysis focused on the odds ratio of having uterine rupture after a myomectomy and the trends over the years. Of a total 54,146 myomectomies, there were 237 uterine ruptures, which stands for 0.43 %. Mean age was 31.8 years, mainly Caucasians and had private insurance. The procedure was performed mainly by laparotomy with 97.7 %, and 2.3 % were performed by laparoscopy. There was a decrease of total myomectomies from 6646 in 2005–4589 in 2014. The numbers of uterine rupture per 1,000 myomectomies were 4.2 after laparotomy and 10.6 after laparoscopic approach. The myomectomy trend changed in recent years with a greater predominance of laparotomies over laparoscopies. Laparoscopic myomectomy may by itself increase the risk for uterine rupture compared to open approach.