[Uterine artery embolization with resorbable material prior to myomectomy].
OBJECTIVE
Fibroids are a frequent cause of gynecology referral. Myomectomy is a conservative treatment alternative. The main risk from this procedure is hemorrhage. The main objective of this study was to demonstrate the efficacy of preoperative uterine artery embolization with resorbable agents to reduce blood losses and facilitate myomectomy. Secondary objectives were to evaluate morbidity and subsequent fertility.


METHODS
Retrospective study of 21 patients with preoperative uterine artery embolization prior to myomectomy at the University Medical Center of Dijon over a 3 year period.


RESULTS
Myomectomy after uterine artery embolization with resorbable agents was associated with only minimal blood loss. Mean preoperative and postoperative hemoglobin levels were comparable (p<0.0001). Uterine suturing was technically simpler. The number of resected fibroids (p=0.2824) and the presence of preoperative anemia (p=0.474) had no statistically significant impact on the duration of hospital stay. Uterine synechiae occurred in three patients after the procedure, and were easily treated. Two patients had normal subsequent pregnancies.


CONCLUSIONS
Preoperative uterine artery embolization with resorbable agents was effective in reducing surgical blood losses. This technique reduces the number of hysterectomies and hemorrhagic complications (hematoma, infection, weaker scar tissue). It should be considered in patients wishing uterine preservation when the hemorrhagic risk is high. Its use in patients seeking subsequent pregnancy should be further assessed with larger series.
Tixier
H
H
Service de Gynécologie-Obstétrique, Médecine Foetale et Stérilité Conjugale, BP 77908, 21079 Dijon Cedex, France. herve_tixier@yahoo.fr
Loffroy
R
R
Filipuzzi
L
L
Grevoul
J
J
Mutamba
W
W
Cercueil
Jp
J
Krausé
D
D
Douvier
S
S
Sagot
P
P
D000328:Adult; D005260:Female; D005781:Gelatin Sponge, Absorbable; D006490:Hemostatics; D006801:Humans; D007889:Leiomyoma / Q000601:surgery; D011300:Preoperative Care; D012189:Retrospective Studies; D055357:Uterine Artery Embolization / Q000379:methods*; D014594:Uterine Neoplasms / Q000601:surgery
D006490:Hemostatics