Perioperative factors associated with delayed passage of flatus after laparoscopic uterine myomectomy: a single-center retrospective cohort study

Introduction Delayed passage of flatus (DPF) after laparoscopic uterine myomectomy may indicate slower gastrointestinal recovery, but procedure-specific evidence is limited. Methods We conducted a single-center retrospective cohort study of 342 consecutive adult patients who underwent laparoscopic uterine myomectomy between March 2021 and March 2025. The endpoint was no documented passage of flatus within the first 3 postoperative days. Because oral-intake intolerance, nausea or vomiting, abdominal distension, and nasogastric-tube use were not systematically captured, the endpoint was treated as DPF rather than consensus-defined postoperative ileus. A three-variable logistic regression model was restricted to preoperative and intraoperative variables and interpreted as an exploratory association model. Results DPF occurred in 35 patients (10.2%). Plain radiographs in all 35 patients meeting this threshold showed multiple air-fluid levels and diffuse small- and large-bowel gas. No focal mechanical obstruction was documented after record review that included bedside abdominal findings and radiography. In the primary complete-case model (341 patients; 35 events), pre-existing constipation (odds ratio [OR] 12.84, 95% confidence interval [CI] 3.65–45.21), intraoperative intestinal adhesion (OR 39.91, 95% CI 13.89–114.71), and operative time (OR 1.014 per minute, 95% CI 1.006–1.023) remained associated with DPF after adjustment. The wide CIs, particularly for intestinal adhesion, indicated substantial uncertainty in the magnitude of association. The model had an apparent area under the receiver-operating characteristic curve of 0.939 (bootstrap 95% CI 0.894–0.978) and a Brier score of 0.040. At the data-derived Youden-index threshold, apparent sensitivity was 0.857 and apparent specificity was 0.908. A single 5-fold cross-validation yielded an area under the curve of 0.923. Discussion These center-specific findings are hypothesis-generating and require prospective external validation using a multidimensional gastrointestinal-recovery endpoint.