Design: Single center retrospective study.

Setting: High-volume academic medical center.

Patients or Participants: Patients undergoing repeat abdominal, laparoscopic, or robotic-assisted myomectomy from January 2022 to March 2024.

Interventions: N/A.

Measurements and Main Results: A total of 65 of 1093 cases (6%) were identified as repeat myomectomies. Mean patient age was 41 years. Cases were performed by fellowship trained gynecologic surgeons (76.9%) and general gynecologists (23.1%). Repeat myomectomy was predominantly performed via abdominal route (81.5%), followed by laparoscopic (10.8%), and robotic assisted (7.7%) routes. Most patients undergoing repeat surgery had a history of prior abdominal myomectomy (67.8%), followed by laparoscopic (13.8%), robotic-assisted (9.2%), and 6 patients (9.2%) had two prior myomectomies. On average, repeat myomectomy was performed 8.7 years after primary myomectomy. Mean total number of fibroids removed was 25.6 (range 1-87). Overall transfusion rate was 7.7%. 2 cases (3.1%) were complicated by bowel injury. 38.5% of repeat myomectomies had significant intra-abdominal adhesions, 20% mild adhesions, and 41.5% no adhesions. A chi-square test of independence confirmed a significant association between the route of prior myomectomy and presence of adhesions (p<0.001); namely prior abdominal myomectomy was associated with current adhesive disease. Comparing abdominal and minimally invasive repeat myomectomies, there was no significant difference in mean estimated blood loss (381 mL vs. 248 mL, p=0.21) or mean operative time (157 vs. 151 minutes, p= 0. 79). There were no bladder injuries, unplanned overnight admissions, readmissions or reoperations.

Conclusion: Although uncommonly performed, we found that repeat myomectomy is generally safe. Most cases were complicated by adhesive disease, although transfusions and bowel injury were overall rare. Our rate of perioperative blood transfusion is consistent with published rates after myomectomy. However, our rate of bowel injury was higher than published rates for benign gynecologic surgery. Our findings can aide in pre-operative counseling of patients prior to undergoing repeat myomectomy.