Blood Loss from Transverse Versus Longitudinal Uterine Incision in Abdominal Myomectomy: a Randomized Controlled Trial

Overview

Journal BMC Womens Health

Publisher Biomed Central

Specialty Gynecology & Obstetrics

Date 2020 Dec 28

PMID 33357218

Citations 2

Authors

Alaa Elguindy

Hosam Hemeda

Mohamed Esmat Shawky

Mohamed Elsenity

Medhat Adel Elsayed

Ahmed Fahim

Khaled Afifi

Maii Nawara

Affiliations

Soon will be listed here.

Abstract

Background: It is unclear whether transverse uterine incision is non-inferior to longitudinal incision during myomectomy with regard to bleeding. Our aim was to compare between transverse and longitudinal uterine incisions in myomectomy.

Methods: A parallel randomized controlled single-blinded study in a university affiliated hospital, in the period between January 2017 and April 2018, in which 52 women candidates for abdominal myomectomy were randomized into transverse uterine incision or longitudinal uterine incision groups (26 in each group). Intraoperative blood loss (estimated directly by blood volume in suction bottle and linen towels and indirectly by difference between preoperative and postoperative hematocrit), operative time and postoperative fever were analyzed.

Results: No statistically significant difference was found between transverse and longitudinal incisions regarding intraoperative blood loss (389.7 ± 98.56 ml vs 485.04 ± 230.6 ml respectively, p value = 0.07), operative time (59.96 ± 16.78 min vs 66.58 ± 17.33 min respectively, p value = 0.18), and postoperative fever (4% vs 8.33%, p value = 0.6).

Conclusion: Transverse uterine incision does not cause more blood loss than longitudinal incision and is a reasonable option during abdominal myomectomy.

Trial Registration: NCT03009812 at clinicaltrials.gov, registered January 2017.

Citing Articles

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Zhang W, Wang D, Xu G, Chen M Am J Transl Res. 2023; 14(12):9040-9046.

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References

Shokeir T, Shalaby H, Nabil H, Barakat R . RETRACTED: Reducing blood loss at abdominal myomectomy with preoperative use of dinoprostone intravaginal suppository: a randomized placebo-controlled pilot study. Eur J Obstet Gynecol Reprod Biol. 2012; 166(1):61-4. DOI: 10.1016/j.ejogrb.2012.09.014. View

Celik H, Sapmaz E . Use of a single preoperative dose of misoprostol is efficacious for patients who undergo abdominal myomectomy. Fertil Steril. 2003; 79(5):1207-10. DOI: 10.1016/s0015-0282(03)00076-1. View

Takamoto N, Leppert P, Yu S . Cell death and proliferation and its relation to collagen degradation in uterine involution of rat. Connect Tissue Res. 1998; 37(3-4):163-75. DOI: 10.3109/03008209809002436. View

Al Kadri H, Al Anazi B, Tamim H . Visual estimation versus gravimetric measurement of postpartum blood loss: a prospective cohort study. Arch Gynecol Obstet. 2010; 283(6):1207-13. DOI: 10.1007/s00404-010-1522-1. View

Dubuisson J, Chavet X, Chapron C, Gregorakis S, Morice P . Uterine rupture during pregnancy after laparoscopic myomectomy. Hum Reprod. 1995; 10(6):1475-7. View

Holzer A, Jirecek S, Illievich U, Huber J, Wenzl R . Laparoscopic versus open myomectomy: a double-blind study to evaluate postoperative pain. Anesth Analg. 2006; 102(5):1480-4. DOI: 10.1213/01.ane.0000204321.85599.0d. View

Igarashi M . Value of myomectomy in the treatment of infertility. Fertil Steril. 1993; 59(6):1331-2; author reply 1332-3. DOI: 10.1016/s0015-0282(16)56003-8. View

Hurst B, Matthews M, Marshburn P . Laparoscopic myomectomy for symptomatic uterine myomas. Fertil Steril. 2005; 83(1):1-23. DOI: 10.1016/j.fertnstert.2004.09.011. View

DSilva E, Muda A, Safiee A, Ghazali W . Five-Year Lapsed: Review of Laparoscopic Myomectomy versus Open Myomectomy in Putrajaya Hospital. Gynecol Minim Invasive Ther. 2018; 7(4):161-166. PMC: 6172868. DOI: 10.4103/GMIT.GMIT_38_18. View

10.

Greene R, Fitzpatrick C, Turner M . What are the maternal implications of a classical caesarean section?. J Obstet Gynaecol. 2004; 18(4):345-7. DOI: 10.1080/01443619867083. View

11.

Schuring A, Garcia-Rocha G, Schlosser H, Greb R, Kiesel L, Schippert C . Perioperative complications in conventional and microsurgical abdominal myomectomy. Arch Gynecol Obstet. 2010; 284(1):137-44. DOI: 10.1007/s00404-010-1622-y. View

12.

Sawin S, Pilevsky N, Berlin J, Barnhart K . Comparability of perioperative morbidity between abdominal myomectomy and hysterectomy for women with uterine leiomyomas. Am J Obstet Gynecol. 2000; 183(6):1448-55. DOI: 10.1067/mob.2000.107730. View

13.

Iverson Jr R, Chelmow D, Strohbehn K, Waldman L, Evantash E, Aronson M . Myomectomy fever: testing the dogma. Fertil Steril. 1999; 72(1):104-8. DOI: 10.1016/s0015-0282(99)00156-9. View

14.

Seracchioli R, Rossi S, Govoni F, Rossi E, Venturoli S, Bulletti C . Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy. Hum Reprod. 2000; 15(12):2663-8. DOI: 10.1093/humrep/15.12.2663. View

15.

Halperin M, Moore D, Hannah W . Classical versus low-segment transverse incision for preterm caesarean section: maternal complications and outcome of subsequent pregnancies. Br J Obstet Gynaecol. 1988; 95(10):990-6. DOI: 10.1111/j.1471-0528.1988.tb06502.x. View

16.

Farrer-Brown G, BEILBY J, Tarbit M . The blood supply of the uterus. 1. Arterial vasculature. J Obstet Gynaecol Br Commonw. 1970; 77(8):673-81. DOI: 10.1111/j.1471-0528.1970.tb03592.x. View

17.

Stewart E, Cookson C, Gandolfo R, Schulze-Rath R . Epidemiology of uterine fibroids: a systematic review. BJOG. 2017; 124(10):1501-1512. DOI: 10.1111/1471-0528.14640. View

18.

Morita M, Asakawa Y, Uchiide I, Nakakuma M, Kubo H . Surgery results using different uterine wall incision directions in laparoscopic myomectomy of the intramural myoma. Reprod Med Biol. 2018; 3(1):33-37. PMC: 5906849. DOI: 10.1111/j.1447-0578.2004.00049.x. View

19.

Tinelli A, Mettler L, Malvasi A, Hurst B, Catherino W, Mynbaev O . Impact of surgical approach on blood loss during intracapsular myomectomy. Minim Invasive Ther Allied Technol. 2013; 23(2):87-95. DOI: 10.3109/13645706.2013.839951. View

20.

Vavilis D, Togaridou E, Agorastos T . Abdominal myomectomy and febrile morbidity. Int J Gynaecol Obstet. 2004; 88(1):61-2. DOI: 10.1016/j.ijgo.2004.09.021. View