Incidence, Diagnosis and Treatment of Broad Ligament Fibroids in Women Undergoing Minimally Invasive (MIS) Myomectomy: A Chart Review

Study Objective The incidence of broad ligament fibroids is reported to be approximately 1% in the literature, however based on our surgical population, we propose that the incidence is much higher. Broad ligament fibroids are commonly misdiagnosed on preoperative MRI imaging. We aim to determine preoperative imaging characteristics that suggest a diagnosis of broad ligament fibroid. We aim to determine the true incidence of broad ligament fibroids in women undergoing MIS myomectomy at a single institution. Design Retrospective chart review was performed to identify preoperative imaging, operative reports, and postoperative data in the acute postoperative period (10 weeks following surgery). Setting N/A. Patients or Participants Patients were identified for inclusion via review of the surgical schedule during the study period (January 2018 – December 2020). Women ≥18 years-old undergoing MIS myomectomy were eligible for inclusion. 227 patients were identified for inclusion and chart review. Interventions N/A. Measurements and Main Results A total of 27 (11.9%) patients were identified to have a broad ligament fibroid at the time of surgery. One additional patient was identified in whom the fibroid had significant adhesions to the broad ligament but did not arise from the broad ligament itself. No patients had preoperative imaging correctly identifying the location of the fibroid as within the broad ligament. Complications included pelvic sidewall hematoma (1), thermal colon injury (1), postoperative hypotension (1), incisional hernia (1), readmission for hemoperitoneum (1), reoperation for hemoperitoneum (1), incisional cellulitis (1), and unexpected salpingo-oophorectomy secondary to adhesions (1). Conclusion The 11.9% incidence reported here is significantly higher than previously reported. Correct preoperative diagnosis is exceedingly rare, making accurate surgical counseling difficult. A goal of gynecologic imaging should be to identify common characteristics of broad ligament fibroids on MRI imaging because such patients can have increased rates of complications after MIS myomectomy. Accurate imaging and preoperative diagnosis are critical for proper surgical counseling, planning and intraoperative management.