Gonadotropin-releasing hormone agonist in laparoscopic myomectomy: systematic review and meta-analysis of randomized controlled trials

Literature Review Article

Gonadotropin-Releasing Hormone Agonist in Laparoscopic Myomectomy: Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Minim Invasive Gynecol. 2011 May-Jun;18(3):303-9.

Review
Paul C. Lin, M.D.

This study is a metaanalysis on the efficacy of Gonadotropin-Releasing Hormone Agonist (GnRHa) therapy prior to laparoscopic myomectomy. Using the standard MEDLINE database, randomized controlled trials comparing GnRHa pretreatment with placebo versus GnRHa before a planned laparoscopic myomectomy, were sought. Three studies were ultimately included in the review.

After review, operating room times were not reduced. Intraoperative bleeding was subjectively noted to be reduced, but could not be validated with postoperative HGB levels. Limitations were acknowledged: a small number of eligible studies, all studies were from Italy, and significant heterogeneity in subjects. The authors concluded that there was no difference in operating time and a reduction in intraoperative bleeding.

Comments
Daniel B. Williams, M.D.

This is a meta-analysis reviewed study which evaluated the effectiveness of the pre-operative use of GnRH agonist in laparoscopic myomectomy. While the authors concluded that there was a reduction in intraoperative bleeding, this was a subjective finding, and objective findings such as post operative HGB, did not validate these findings.  Furthermore, there are a number of limitations of the three studies that were included (as listed above). Based on these results, routine use of a GnRH agonist prior to laparoscopic myomectomy cannot be recommended. Certainly, additional controlled trials would be needed to more adequately answer this question.

The above review and commentary on this article were written by SRS members. Publication of these summaries does not reflect endorsement of any particular procedure or treatment. Views expressed in these summaries do not necessarily reflect the views of SRS or ASRM.

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