In Low- and Middle-Income Countries the Uterine Tourniquet during Open Myomectomy is a Simple and Efficient Method of Reducing Blood Loss

Abstract

Background: Uterine fibroids are the most common form of benign uterine tumors. African women of reproductive age usually present late with large and numerous uterine fibroids. Conservative surgical treatment requires ways to reduce intraoperative bleeding. This study attempts to describe innovative methods in the efficient management of fibroids in low-and middle incomes countries. We demonstrate the efficiency of the uterine tourniquet during abdominal polymyomectomy in intraoperative bleeding reduction despite removal of numerous myomas. Methods: A prospective, descriptive and analytical review was conducted on 92 patients who underwent open myomectomy in the gynecology department of the university hospital of Cocody (Côte d'Ivoire) over 3 years (2019 to 2020). Intraoperative surgical steps include placing a uterine tourniquet before removal of the myomas. The variations in mean hemoglobin levels before and after myomectomies were compared. The significance level was set at 5% (p < 0.05). Results: The patients' mean age was 38.5 years old, and 39% were nulliparous. Abnormal vaginal bleeding was the main symptom (67.4%). On physical exam the uterine size varied significantly from 20 to 30 cm. The average number of uterine fibroids enucleated was ten. The mean duration of the procedure was 155 minutes with an estimated average blood loss of 250 mL. The mean difference between preoperative and postoperative hemoglobin levels was not significant (p < 0.061). Only four patients (4.3%) received a blood transfusion. Conclusions: Placing a uterine tourniquet allowed enucleation of several uterine fibroids with relatively reduced blood loss in abdominal myomectomies. This technique can be an alternative to embolization in countries with limited resources.