Perioperative vaginal misoprostol versus intraoperative pericervical hemostatic tourniquet outcome during abdominal myomectomy: A systematic review and meta-analysis

Abstract

Background: Abdominal myomectomy is a commonly performed surgical procedure for removing fibroids. Various techniques and interventions have been explored to minimize blood loss during abdominal myomectomy. This study aims to assess and compare the efficacy of perioperative vaginal misoprostol and intraoperative pericervical hemostatic tourniquet in minimizing blood loss during abdominal myomectomy. Method: Eligible studies were identified using several databases. Analysis was conducted using RevMan version 5.3. This systematic review and meta-analysis were registered in PROSPERO on June 20, 2023, with registration number CRD42023434191. We included three studies with 88 participants. Results: Of the 73 records identified initially, 3 met the inclusion criteria—sample sizes of the included studies involving 88 participants. There was a significant mean difference in intraoperative blood loss ( p = 0.022 (95% CI, 0.0706–0.901) and operative time ( p = 0.015, 95% CI, 0.116–1.066) between groups. There was no significant mean difference in postoperative hematocrit ( p = 0.053 (95% CI, −0.734 to 0.00411)) and intraoperative blood transfusion (OR = 1.60 (95% CI, 0.587–4.405), p = 0.355)) between group. Conclusion: Our studies indicate that using tourniquets lowered intraoperative bleeding and shortened operating time among the participants. Intraoperative vaginal misoprostol has no significant advantage over the tourniquet group in either intraoperative blood transfusion needs or postoperative hematocrit.