Background: Single and triple uterine tourniquet significantly reduces blood loss during myomectomy and both are highly effective. Triple tourniquet, however, blocks ovarian circulation and there is doubt that it causes ischemic damage to ovaries. These 2 methods have not been compared by a randomised controlled study yet. The purpose of this study was to compare triple uterine tourniquet with single tourniquet in terms of blood loss during open myomectomy. Material and Methods: Womenwere randomized to triple (n = 24) or to single tourniquet (n = 24) at open myomectomy. All women with a myomatous uterus greater than 12 weeks of gestation were eligible to be part of the study. The primary outcome of the study was the amount of blood loss during surgery. Sample size was set to detect a 250 mL difference in blood loss with 80% power at α = 0.05. We also compared the change in anti-Müllerian Hormone (AMH) levels before and after surgery. Results: There was no significant difference in the outcome of blood loss between triple and single uterine tourniquet (322 ± 223 vs. 426 ± 355 mL, p = 0.230). Change in AMH was not different between the groups. Conclusions: There is no clinically significant difference between triple and single uterine tourniquets on blood loss at open myomectomy.
Purpose: The purpose of this study was to compare triple uterine tourniquet to single tourniquet on intraoperative blood loss at open myomectomy.Methods: Women were randomized to undergo open myomectomy with triple (n=30) or single uterine tourniquet (n=30). All symptomatic women aged 18-48 who have a three or more myoma or at least one myoma greater than 8 cm if there is less than three myoma were eligible to study. The primary outcome variable of the study was amount of intraoperative blood loss. Sample size was set to detect a 240 ml difference in blood loss with 80% power at α=0.05 with an effect size of 0.8. The rate of transfusions, change in hemoglobin, volume in drains, operation time, tourniquet time and perioperative complications were secondary outcomes.Results: We found no significant difference in intraoperative blood loss between triple and single uterine tourniquet (527[102-2931]) ml vs. 508[172-2764] ml, p=0.238). Between single and triple tourniquet groups, the median weight of myoma (379[136-3850] vs.330[140-1636] g, p=.451) and median number of it (1[1-18] vs. 2(1-13), p=0.214), total operation time (84±31 min. vs. 79±27 min., p=0.503), ischemia time (35±21 min. vs. 30±14 min., p=0.238), drain volume at 48th hour (196±89)ml vs. 243±148 ml , p=0.144) and decrease in hemoglobin (2,3±1,8 g/dL vs. 2,8±1,4 g/dL, p=0.437) were similar. Eight (27%) patients in triple tourniquet group and 12 (40%) in single tourniquet group were transfused (p=0.273). One patient underwent hysterectomy 6-8 hours after myomectomy in single tourniquet group.Conclusion: There is no clinically significant difference between triple and single uterine tourniquets on intraoperative blood loss at open myomectomy.Clinical Trial Registration Number and date of registration: ClinicalTrials.gov ID: NCT02392585, 03/13/2015.
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