Adjunctive Uterine Incision Compression Versus Tourniquet Alone for Reduction of Blood Loss During Abdominal Myomectomy: A Randomized Controlled Trial

Abstract

Introduction: The effectiveness of the uterine tourniquet alone for securing hemostasis during abdominal myomectomy remains debatable; however, its combination with uterine compression though popular has very scanty documented evidence of hemostatic efficacy. Aim: To determine the effect of uterine incision compression (UIC) combined with tourniquet on operative blood loss associated with abdominal myomectomy. Materials and Methods: A multicenter randomized double blind, controlled trial involving 184 participants randomized into two groups: 92 in the UIC and 92 in the control arm. UIC was administered in the interval from release of the uterine tourniquet to palpation of contraction. Data were analyzed using the Statistical Package for the Social Sciences (SPSS), version 21. Results: The mean intraoperative blood loss was lower in the UIC group (951.41 ± 362.32 mL) than in the control group (1051.30 ± 427.77 mL), but did not reach statistical significance (p = 0.125). The observed mean duration of myomectomy was, however, longer among the controls (152.95 ± 32.67 min, compared with 119.70 ± 23.96 min, p = 0.001). The control group also had significantly higher rates of deployment of additional hemostatic measures (OR = 4.68, 95% CI = 2.304–12.784, p = 0.001), occurrence of postoperative pyrexia (OR = 1.65, 95% CI = 1.256–2.154, p = 0.002), and greater mean postoperative blood loss (p = 0.003). Conclusion: Although no statistically significant difference occurred in intraoperative blood loss, adjunctive UIC was useful in reducing operating time and postoperative blood loss.

Keywords

• compression
• hemorrhage
• incision
• myomectomy
• tourniquet