Comparative Study of Preoperative Misoprostol versus Intraoperative Hemostatic Uterine Artery Ligation in Reducing Blood Loss in Cases of Myomectomy

Abstract

Background: Myomectomy is a common surgical intervention for the removal of uterine fibroids. Excessive blood loss during the procedure remains a concern. However, there is currently no agreement on the optimal method for minimizing blood loss during myomectomy procedures.Aim of the Work: This comparative study aimed to assess the efficacy of two approaches, namely preoperative misoprostol administration and intraoperative cervical hemostatic uterine artery ligation, in reducing intraoperative blood loss.Patients and Methods: A prospective randomized controlled trial was conducted, including a total of 80 patients undergoing myomectomy for symptomatic uterine fibroids. These patients were divided into two groups: Group A [40 patients] received preoperative misoprostol and Group B [40 patients] underwent intraoperative cervical hemostatic uterine artery ligation. The primary outcome measure was the difference in blood loss between the two groups. Secondary outcomes included operation time, postoperative hemoglobin levels and transfusion rates. Results: The findings revealed that the amount blood loss was significantly less in Uterine Artery Ligation group. The mean blood loss in Group A was 440.0±78.1 ml, while in Group B, it was 375.0±96.3 ml [p 0.006]. Furthermore, Group B demonstrated a lower transfusion rate and higher postoperative hemoglobin levels compared to Group A.Conclusion: Intraoperative cervical hemostatic uterine artery ligation was found to be more effective than preoperative misoprostol administration in reducing blood loss during myomectomy procedures. This technique shows promise in improving surgical outcomes, minimizing blood loss, and potentially reducing the need for blood transfusion, but further research and long-term follow-up studies are needed for validation and to determine its clinical significance.

Keywords

• leiomyoma
• misoprostol
• uterine artery
• uterine myomectomy
• surgical blood loss