The role of tourniquet in myomectomy: an observational study

Leimymoma is one of the commonest benign tumours encountered in women during the reproductive age. One quarter of these women may be symptomatic. When surgical management is indicated, myomectomy may be considered as the procedure of choice. Myomectomy can be complicated by severe intraoperative haemorrhage. One of the methods to reduce blood loss during myomectomy is the mechanical application of tourniquet.

A prospective observational single arm study was done with 24 women who underwent open myomectomy to determine the utility of tourniquet in reducing blood loss during the procedure. Women of reproductive age group, having symptomatic fibroid, not responding to medical therapy, not completed their family and with total uterine size not exceeding 20 weeks were included in the study while those with pregnancy, concomitant adenomyosis, cervical or broad ligament fibroid, bleeding diathesis were excluded. The 7-French pediatric feeding tube was used as tourniquet. Our primary end point was intra-operative blood loss. Secondary outcome measures included operative morbidity and blood transfusion rates.

It was seen that application of the tourniquet considerably reduced the amount of blood loss and made resection of the myoma much easier. 83.3% patients had a blood loss less than 200ml and the rest between 200ml and 400ml. For majority of the patients (75%) the postoperative change of PCV was between 1 and 2%.

The infant feeding tube form of tourniquet is cheap, safe, readily available, effectively reduces blood loss during myomectomy while not adding to the complications due to the operation. Metrics

Younas K, Hadoura E, Majoko F, Bunkheila A. A review of evidence‐based management of uterine fibroids. TObstet Gynaecol. 2016;18(1):33-42. Parazzini F. Risk factors for clinically diagnosed uterine fibroids in women around menopause. Maturitas. 2006;55(2):174-9. Okolo S. Incidence, aetiology and epidemiology of uterine fibroids. Best Pract Res Clinic Obstet Gynaecol. 2008;22(4):571-88. Zimmermann A, Bernuit D, Gerlinger C, Schaefers M, Geppert K. Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women. BMC Women's Health. 2012;12(1):6. Ryan GL, Syrop CH, Van Voorhis BJ. Role, epidemiology, and natural history of benign uterine mass lesions. Clinic Obstet Gynecol. 2005;48(2):312-24. Manyonda I, Sinthamoney E, Belli AM. Controversies and challenges in the modern management of uterine fibroids. BJOG: Int J Obstet Gynaecol. 2004;111(2):95-102. Paul GP, Naik SA, Madhu KN, Thomas T. Complications of laparoscopic myomectomy: a single surgeon’s series of 1001 cases. Aus NZ J Obstet Gynaecol. 2010;50(4):385-90. Kongnyuy EJ, Wiysonge CS. Interventions to reduce haemorrhage during myomectomy for fibroids. Cochrane Database Syst Rev. 2014;8:CD005355. Dubuisson JB, Fauconnier A, Fourchotte V, Babaki-Fard K, Coste J, Chapron C. Laparoscopic myomectomy: predicting the risk of conversion to an open procedure. Human Reproduct. 2001;16(8):1726-31. Chittawar PB, Franik S, Pouwer AW, Farquhar C. Minimally invasive surgical techniques versus open myomectomy for uterine fibroids. Cochrane Database of Systematic Reviews. 2014(10). Alexander W. M Press and Circular, 1898; 66:349. Lock FR. Multiple myomectomy. Am J Obstet Gynecol 1969;104(5):642-50. Akinyemi O, Adewoye BR, Fakoya TA. Uterine Fibroids; a review. Niger J Med. 2004:13(4):318-29. Bonney V. The technique and results of myomectomy. Lancet 1931;220(5604):171-7. Thompson JD, Rock JA. Leiomyomata uteri and myomectomy. In: ThompsonJD, RockJA,editors. TeLinde’s Operative Gynaecology. Philadelphia: Lippincott-Raven Publishers, 1997:731–770. Talandi T, Beique F, Kimia M. Pulmonary oedema, a complication of local injection of vasopressin at laparoscopy. Fertil Steril. 1996:(66):478-80. Martin JD, Shenk LG. Intraoperative myocardial infarction after paracervical vasopressin infiltration. Anesthes Anal. 1994;79(6):1201-2. Nezhat F, Admon D, Nezhat CH, Dicorpo JE, Nezhat C. Life-threatening hypotension after vasopressin injection during operative laparoscopy, followed by uneventful repeat laparoscopy. J Am Associat Gynecol Laparoscop. 1994;2(1):83-6. Vercellini P, Trespìdi L, Zaina B, Vicentini S, Stellato G, Crosignani PG. Gonadotropin-releasing hormone agonist treatment before abdominal myomectomy: a controlled trial. Fertil and Steril. 2003;79(6):1390-5. Kongnyuy EJ, Wiysonge CS. Interventions to reduce haemorrhage during myomectomy for fibroids. Cochrane Database of Systematic Reviews. 2014;(8): CD005355. JI Ikechebelu, CO Ezeama, Obiechina NJA. The use of tourniquet to reduce blood loss at myomectomy. Nigerian J Clinic Pract. 2010;13(2):154-8.