Per-Cervical Uterine Artery Tourniquet Versus Rectal Misoprostol in Reducing Blood Loss During Abdominal Myomectomy: A Randomized Controlled Clinical Trial

Volume 4 - Issue 1

Hossam M Abd-Elnaby*

Received: December 20, 2019;   Published: January 21, 2020

DOI: 10.32474/IGWHC.2020.04.000179

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Abstract

Introduction: Uterine myomas are smooth muscle tumor and uterine connective tissues. Myomas occur in women of reproductive age who may represent menorrhagia, abdominal weight, effects of stress and infertility. Myomas symptoms may be affected by the tumor’s size, number, and site. Myomectomy is known as a significant option for women with symptomatic leiomyomas and want potential pregnancy. Myomectomy is the removal of myoma(s) from the womb. Often intraoperative bleeding is often an issue in this procedure, suggesting blood transfusion in up to 20 percent of women and conversion to hysterectomy in 2 percent of women. Therefore, during abdominal myomectomy, several approaches are used to minimize blood loss. One of these is uterine artery interventions such as; peri cervical mechanical tourniquet, bilateral uterine ligation, embolization of the uterine artery, and hormonal tourniquets such as vasopressin. One of these methods is also uterotonics such as (misoprostol and oxytocin) and antifibrinolytic agents such as (tranexamic acid).

Objective: To compare the efficacy of peri cervical mechanical tourniquet with pre-operative rectal misoprostol in decreasing blood loss during abdominal myomectomy.

Materials and methods: Seventy-two women with symptomatic uterine leiomyomas and meeting the study inclusion criteria were scheduled to undergo abdominal myomectomy. Patients were randomly divided into two groups Group A: Including 36 in which patients underwent peri cervical mechanical tourniquet in which an incision of about 1 cm was made in a clear space at the internal os bilaterally then a Foley’s catheter was applied as tourniquet through the incisions.

Group B: Including 36 patients receiving 400 micrograms of rectal misoprostol 1 hour before the procedure.

Outcome measures: Primary outcome: Estimating blood loss intraoperation and blood transfusion need. There was a need for intraoperative blood transfusion when intraoperative blood loss exceeds 15 percent of the estimated blood volume of the patient, which is equal to the weight of the patient in (Kg) multiplied by 10. Secondary outcome: The need for myomectomy-to-hysterectomy transformation. Total operating time (measured from the beginning of the skin incision till closure. Difference between hemoglobin and hematocrit levels pre-and post-operative. (Measures for postoperative outcome: included. Venous blood samples of hemoglobin and hematocrit levels were taken from patients after 24 h to avoid false results due to hemodilution by intravenous fluids in the first 24 h). Hospital time (based on the well-being of the patient, lack of anemia, simple ambulation, bowel motility and clean wound.

Results: The difference in intraoperative blood loss between the two groups was 24.5 ml with more blood loss in the misoprostol band, yet there was no statistically significant difference in estimated intraoperative blood loss between the two groups. There was no statistically significant difference in the need for blood transfusion between 2 groups in this study, 48 patients (66.7%) had no complications, 8 patients (11.1%) needed post-operative blood transfusion and were all in the misoprostol group, and 16 patients (22.2%) had post-operative fever; while 12 patients were in the misoprostol group and 4 patients were in the uterine tourniquet group, there was no need for patients to convert from myomectomy to hysterectomy. between the two groups. There was a statistically significant difference in postoperative complications. There was no statistically significant difference in hospital stay and drain collection between the two groups.

Conclusion: Peri cervical mechanical tourniquet compared to preoperative rectal misoprostol is more effective in minimizing blood loss intraoperatively and postoperatively in addition to shortening operating time. However, the tourniquet may need additional professional surgical skills.

Keywords:Blood loss; Fibroid; Myomectomy; Uterine artery tourniquet; Rectal misoprostol

Abstract| Introduction| Patients & Methods| Outcome Measures| Result| Discussion| Conclusion| Strength and Limitations| References|