20530
document
Reducing blood loss at open myomectomy using triple tourniquets : a randomised controlled trial . OBJECTIVES To evaluate triple tourniquets in controlled conditions and for the first time to investigate the hypothesis that leaving a semi-permanent tourniquet around the uterine artery reduces post-operative bleeding from the uterine incisions . DESIGN A randomised controlled trial . SETTING Two University teaching hospitals . POPULATION Twenty-eight patients with symptomatic fibroids and uterine sizes ranging from 14 to 24 weeks of gestation undergoing open myomectomy . METHODS A number 1 polyglactin suture was tied around the cervix to occlude the uterine arteries , and polythene tourniquets were tied around the infundibulopelvic ligament to obstruct the ovarian vessels . At the end of the procedure , the ovarian ties were released but the uterine artery suture remained in situ . MAIN OUTCOME MEASURES Intra-operative blood loss , post-operative blood loss , blood transfusion rates , operative morbidity , uterine blood flow and ovarian function . RESULTS There was significantly less blood lost in the tourniquet group than in the control group ( difference between means 1870 mL , 95 % CI 1159-2580 mL , P < 0.0001 ; transfusion rates of 7 % and 79 % , P= 0.0003 ) . The volume in the pelvic drain 20 min post-operatively and after 48 hours failed to reach statistical significance between the two groups ( P= 0.10 and P= 0.165 ) . There were no differences in uterine artery Doppler resistance indices at five days ( P= 0.54 ) , six weeks ( P= 0.47 ) , three months ( P= 0.49 ) and at six months ( P= 0.18 ) . Day two serum FSH concentrations after surgery were unchanged ( P= 0.45 ) , compared with baseline values . CONCLUSIONS Triple tourniquets are effective in reducing bleeding and transfusion rates . There appears no obvious adverse effect on uterine perfusion or ovarian function .
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Intervention_Surgical
open myomectomy
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Intervention_Surgical
triple tourniquets
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Intervention_Surgical
triple tourniquets
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Intervention_Surgical
myomectomy
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Intervention_Surgical
number 1 polyglactin suture was tied around the cervix to occlude the uterine arteries
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Intervention_Surgical
polythene tourniquets were tied around the infundibulopelvic ligament to obstruct the ovarian vessels
20537
Intervention_Surgical
Triple tourniquets
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Outcome_Other
blood loss
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Outcome_Physical
Intra-operative blood loss , post-operative blood loss , blood transfusion rates , operative morbidity , uterine blood flow and ovarian function .
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Outcome_Mental
less blood lost
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Outcome_Physical
volume in the pelvic drain
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Outcome_Other
no differences
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Outcome_Other
uterine artery Doppler resistance indices
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Outcome_Physical
serum FSH concentrations
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Outcome_Physical
unchanged
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Outcome_Other
bleeding and transfusion rates .
20547
Outcome_Other
uterine perfusion or ovarian function .
20548
Participant_Condition
open myomectomy
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Participant_Sample-size
Twenty-eight
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Participant_Condition
myomectomy