Combining the uterine depletion procedure and myomectomy may be useful for treating symptomatic fibroids

Liu, Wei Min; Tzeng, Chii Ruey; Chen, Yi Jen; Wang, Peng Hui

doi:10.1016/j.fertnstert.2004.01.026

Cited by 100 publications

(90 citation statements)

References 25 publications

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“…22 Even if this effect is clinically small, inducing a degree of temporary uterine ischaemia may reduce the chances of fibroid recurrence as seems to the case after uterine depletion and uterine artery embolisation prior to myomectomy. 23,24 In contrast to permanent procedures such as embolisation and ligation of the uterine vessels, a peri-cervical tourniquet produces only temporary occlusion of the main uterine blood supply, which we feel is theoretically at least an advantage in terms of future obstetric performance. 25 In conclusion, our study confirms that the application of 'triple' tourniquets is more effective than preoperative treatment with GnRH analogues at reducing intra-operative blood loss at open myomectomy.…”

Section: Discussionmentioning

confidence: 96%

Prospective randomised trial comparing gonadotrophin‐releasing hormone analogues with triple tourniquets at open myomectomy

Al-Shabibi

Chapman

Madari

et al. 2009

BJOG

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Objective To compare intra-operative blood loss with triple tourniquets to occlude uterine blood supply against preoperative treatment with gonadotrophin-releasing hormone (GnRH) analogues at open myomectomy.Design A prospective randomised controlled trial.Setting University teaching hospital.Population Forty women undergoing open myomectomy for symptomatic fibroids.Methods Women due to undergo open myomectomy were randomised to either 3 months pre-treatment with a GnRH analogue or the intra-operative application of triple tourniquets (number 1 polyglactin suture [Vicryl Ò Ethicon Inc., Somerville, NJ, USA] tied around the cervix and a size 10 polythene suction catheter tied around the infundibulo-pelvic ligaments) to occlude the uterine blood supply.Main outcome measures The primary outcome measure was intra-operative blood loss. Secondary outcome measures included postoperative blood loss, blood transfusion rate and postoperative morbidity. ResultsThe two groups were similar in baseline characteristics. An average of 15 and 22 fibroids were removed from the GnRH analogue and tourniquet groups respectively. Intra-operative estimated blood loss was significantly higher in the GnRH analogue group (median 2482 ml, 75% percentile 1744-3151) than when triple tourniquets were used (median 640 ml, 75% percentile 418-881), giving a difference between means of 1842 ml (P < 0.001). Similarly, significantly more women required blood transfusion in the GnRH analogue group (70 versus 30%, P < 0.025). Postoperative morbidity was similar between the two groups. There were two serious complications in the tourniquet group, but they were not considered to be directly related to occlusion of the uterine blood supply.Conclusions Triple tourniquets are significantly more effective than preoperative treatment with GnRH analogues at reducing intra-operative blood loss at open myomectomy.

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Section: Discussionmentioning

confidence: 96%

Prospective randomised trial comparing gonadotrophin‐releasing hormone analogues with triple tourniquets at open myomectomy

Al-Shabibi

Chapman

Madari

et al. 2009

BJOG

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“…So, for the women in our series, all large visible myomas were removed by surgery while the small, concealed myomas were treated by the uterine artery blocking procedure. The result was a 96.9% success rate, compared with the published 84.0% success rate in a myomectomy-only series [13].…”

Section: Discussionmentioning

confidence: 65%

Laparoscopic blockage of uterine artery and myomectomy

Liang

Chen

et al. 2006

Surg Endosc

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“…This choice was deliberate, related to the cost, accessibility of this device in our environment. Other teams use the Folley probe [6], the elastic tourniquet [10], the Shirodkar clamp [11] or the resorbable wire [12].…”

Section: Discussionmentioning

confidence: 99%

Contribution of the Tourniquet in the Prevention of Haemorrhages during Myomectomies at the University Hospital of Brazzaville

Itoua¹,

Eouani²,

Ambeto³

et al. 2018

OJOG

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Objective: To check the effectiveness of tourniquet in the prevention of haemorrhage during myomectomies at the University Hospital of Brazzaville. Patients and methods: Analytical cross-sectional study, conducted at the University Hospital of Brazzaville from June 1, 2014 to June 30, 2016. Recruitment was performed by randomly matching each case of myomectomy performed using a tourniquet with two cases of myomectomy without tourniquet (50 cases vs 100 witnesses). We used as a tourniquet, the surgical glove knotted and tightened sufficiently at the level of the isthmus of the uterus to temporarily occlude the uterine arteries to ensure haemostasis lasting no more than one hour. Results: The mean age of the patients was similar in both groups (36, 1 ± 2.2 years vs 36.2 ± 1.9 years, P > 0.05). Menorrhagia was the most common indication of myomectomy in both groups (76% vs. 78% P > 0.05). The mean haemoglobin level of the patients before the myomectomies was 9.03 ± 1.10 g/dl vs 9, 75 ± 1.29 g/dl; P > 0.05. Intraoperative uterine features were similar in size (18 weeks gestation, 14 -24) and number of myomas (5 vs 4, P > 0.05) in both groups. Polymyomectomy was more common in both groups (76% vs 73%, P > 0.05). Blood loss was reduced in the tourniquet group (90.5 ± 4.6 ml vs 200.4 ± 5.6 ml; P < 0.05), as well as the use of blood transfusion (8% vs 50%, P < 0.05). Use of the number of sutures was reduced in the group with tourniquet (3 ± 0.2 vs 6 ± 0.2 P < 0.05). The duration of the procedure was shorter in the group with tourniquet (51.5 ± 4 min vs 83 ± 7 min, P < 0.05). Postoperative mean haemoglobin of patients was no different between the two groups (9.4 ± 0.7 g/dl vs 9.2 ± 0.5, P > 0.05). The overall cost of management was reduced in the group with tourniquet (190,680 ± 1450 F CFA vs 256,800 ± 2350 FCFA; P < 0.05). Conclusion: The use of tourniquet during myomectomies significantly reduces blood loss and the use of blood transfusion. We also obtain the notorious reduction in the use of sutures, the duration of interventions, and the overall cost of care. Thus, we encourage the systematic use of tourniquet during myomectomies by laparotomy.

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Combining the uterine depletion procedure and myomectomy may be useful for treating symptomatic fibroids

Cited by 100 publications

References 25 publications

Prospective randomised trial comparing gonadotrophin‐releasing hormone analogues with triple tourniquets at open myomectomy

Prospective randomised trial comparing gonadotrophin‐releasing hormone analogues with triple tourniquets at open myomectomy

Laparoscopic blockage of uterine artery and myomectomy

Contribution of the Tourniquet in the Prevention of Haemorrhages during Myomectomies at the University Hospital of Brazzaville

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