COMPARING PERIOPERATIVE VAGINAL MISOPROSTOL WITH INTRAOPERATIVE PERICERVICAL HAEMOSTATIC TOURNIQUET IN REDUCING BLOOD LOSS DURING ABDOMINAL MYOMECTOMY
Introduction: Myomectomy is often the preferred surgical option for symptomatic uterine fibroids in women who desire to retain their uterus. However, blood loss at abdominal myomectomy is often significant and may lead to devastating complications.Aim: To compare the effectiveness of perioperative administration of vaginal misoprostol to intra-operative pericervical haemostatic tourniquet in reducing blood loss during abdominal myomectomy.
Methods: The study was a randomized controlled study involving patients with uterine fibroid undergoing abdominal myomectomy. Simple random sampling by balloting was used to randomize the participants into two groups; Group I received perioperative vaginal misoprostol (400μg) and Group II had intra-operative pericervical haemostatic tourniquet. Uterine sizes, location of fibroids and type of anaesthesia were used for matching. The primary outcomes were the intra-operative blood loss and need for intra- operative blood transfusion. The data was analyzed using the SPSS software version 21.0 and p < 0.05 was significant.
Results: The mean intra-operative blood loss was higher in Group I compared to Group II (931.89±602.13ml vs. 848.40±588.85ml, p=0.532). Intra-operative blood transfusion rate (60% vs. 55%; p=0.651) and mean unit of blood transfused (1.30±1.20 vs. 1.20±1.30;p=0.722) were higher for group I compared to group II. There was no statistically significant difference in the change in post-operative haematocrit (2.67±2.21% vs. 3.24±2.85%, p=0.315). The rate of post-operation blood transfusion was 2.5% in Group I and 5% in Group II; p=0.556. None of the participants in the study had conversion of abdominal myomectomy to hysterectomy. Side effects of misoprostol occurred in 8 (20%) of group I participants and abdominal cramps was the commonest [5 (12.5%)].
Conclusion: The effectiveness of perioperative vaginal misoprostol is comparable to intra-operative haemostatic pericervical tourniquet in reducing blood loss during abdominal myomectomy.
Recommendations: Administration of perioperative vaginal misoprostol is recommended for reducing intra-operative blood loss during abdominal myomectomy.