Myomectomies : prévention de l'hémorragie

Myomectomy is a surgical procedure that allows preservation of the uterus in case of myomatous disease. Various surgical approaches may be considered. However, abundant peroperative haemorrhage may occur, resulting in complications such as incomplete surgery, modification of the surgical access, hypovolaemic shock, blood transfusion, and severe postoperative anaemia, necessitating aggressive treatment and transfusion, and delaying activity recovery. Such observations justify in seeking for means able to prevent peroperative haemorrhage. Several medical preoperative means have been strictly evaluated. The preoperative usage of gonadotrophin releasing hormone (Gn-RH) agonists seems to result, after a reduction of the uterine volume by myometrium vascular re-arrangements, in a reduction of peroperative haemorrhage; the results are still debated. Administrations of Gn-RH, misoprostol or antiprogesterone seem promising but further studies are necessary to confirmation. Preoperative embolization of the myoma could reduce peroperative blood loss but the use of this procedure in childbearing women is under evaluation. Peroperative means are available: chemical means such as vasoconstrictive or oxytocic agents, and mechanical means which temporarily interrupt the myometrial blood flow. Some have shown efficacy. As alternatives to surgery, techniques such myolysis – which induces in situ myoma destruction – necessitate further research, particularly regarding young childbearing women.