Uterine Isthmus Tourniquet during Abdominal Myomectomy: Support or Hazard? A Randomized Double-Blind Trial

Abstract

<b><i>Background and Objectives:</i></b> A tourniquet has been suggested as a useful means of reducing massive hemorrhage during myomectomy. However, it is not clear whether the restricted perfusion affects the ovaries. In the present study, we examined the effect of a tourniquet on ovarian reserve and blood loss during myomectomy. <b><i>Materials and Methods:</i></b> In a randomized double-blind clinical trial, fertile nonobese patients scheduled for abdominal myomectomy at Rasool-e-Akram Hospital from February 2018 to June 2019 were randomized to a tourniquet (<i>n</i> = 46) or a non-tourniquet group (<i>n</i> = 35). Serum levels of anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH) were measured before and 3 months after surgery, blood loss was recorded during surgery, and serum levels of hemoglobin (Hb) were recorded before surgery, 6 h and 3 days after surgery. SPSS version 21 was used for statistical analysis. <b><i>Results:</i></b> Demographic, obstetric, and myoma characteristics were similar in the 2 groups (<i>p</i> &#x3e; 0.05). The mean baseline values of AMH and FSH did not differ between groups (<i>p</i> &#x3e; 0.05). After surgery, only FSH was higher in the control group (<i>p</i> = 0.043). Despite the time taken to fasten and open the tourniquet, the mean operating time was shorter in the tourniquet group (<i>p</i> &#x3c; 0.001). Blood loss was higher in the control group (<i>p</i> = 0.005). The drop in Hb levels at 6 h after surgery was higher in the non-tourniquet group (<i>p</i> = 0.002). Blood loss was significantly associated with the duration of surgery (<i>r</i> = 0.523, <i>p</i> &#x3c; 0.001). <b><i>Conclusion:</i></b> The use of a tourniquet during abdominal myomectomy significantly reduced the mean volume of blood loss compared to the non-tourniquet group, while it did not prolong the duration of surgery, nor reduced the ovarian reserve. A tourniquet is a safe and efficient measure during abdominal myomectomy.