The effect of bilateral uterine artery ligation versus intermittent clamping of uterine and ovarian artery on blood loss during abdominal myomectomy : A randomized controlled trial

Abstract

Background: Myomectomies are more commonly performed than hysterectomies, mainly due to the fact that patients desire to retain their uterus for psychological, reproductive and cultural reasons even after completing their families. The average volume of blood loss during abdominal myomectomy is 200 to 800 mL. Surgical hemorrhage may result in anemia, hypovolemia, and coagulation abnormalities.Aim: To compare between bilateral uterine artery ligation and intermittent clamping of uterine and ovarian artery on amount of blood loss during abdominal myomectomy.Patients and Methods: This study was conducted at Ain-Shams University Maternity Hospital on 90 women with symptomatic myomas in the postmenstrual period presented by abnormal uterine bleeding, dull aching lower abdominal pain, dyspareunia, pressure symptoms, progressive abdominal enlargement or pelvic heaviness, diagnosed based on clinical examination and ultrasound scan with pre-operative hemoglobin level above 10gm/dl.Results: The preoperative Hb was 11.6 gm % and 11.8gm% for both clamping and ligation one respectively, and post-operative Hb for the groups was 9.4 gm% and 9.2 gm% for the 2 groups respectively. There was no significant difference between both groups regarding postoperative drop of hemoglobin which was 0.8 gm % in the clamping group and 1.1 gm% in the ligation group. Estimated inraoperative blood loss start was significantly fewer among clamping group than among ligation group. Hemoglobin reduction was significantly fewer among clamping group than among ligation group.Conclusion: Based on the results obtained by this study, intermittent clamping of uterine and ovarian artery is a preferred approach than bilateral uterine artery ligation on blood loss during abdominal myomectomy.