Preoperative embolization or ligature of the uterine arteries in preparation for conservative uterine fibroma surgery.
OBJECTIVE
To compare the efficacy, feasibility and morbidity of two preparation techniques for conservative uterine myoma surgery: temporary embolization and temporary surgical ligature of the uterine arteries.


METHODS
Retrospective study.


METHODS
Gynecological Surgery and Interventional Radiology departments, Centre Hospitalier Universitaire of Dijon, France.


METHODS
A total of 100 women undergoing myomectomy between 2000 and 2008.


METHODS
Three groups were constituted: (1) no preparation (43 patients), (2) uterine artery embolization (UAE) (30 patients) and (3) temporary surgical ligature of the uterine arteries (SLUA) (27 patients). The choice of technique depended on the number, size and topography of the fibromas.


METHODS
Quantification of peroperative blood loss, delta hemoglobin, complications, subsequent fertility.


RESULTS
Blood loss and delta hemoglobin were both lower in group 2 (p = 0.026 and p = 0.0002) and in group 3 (p = 0.048 and p = 0.001), respectively, than in group 1. The two preparation techniques were efficient. SLUA increased the duration of the operation (p < 0.0001). Hospitalization was longer following UAE (p = 0.0001). The rate of complications was 16.3, 23.3 and 3.7%, and of synechiae 9.3, 13.3 and 0% for groups 1, 2 and 3, respectively. The number of pregnancies was 8, 5 and 6 after a mean postoperative period of 5.6, 4.3 and 3.9 years, respectively.


CONCLUSIONS
Both UAE and SLUA for myomectomy are feasible, reproducible and effective techniques for reducing peroperative blood loss. Use of these techniques must be generalized in patients with a high risk of hemorrhage, but may be compatible with subsequent fertility.
Tixier
Hervé
H
Department of Gynecology and Obstetrics, University of Dijon School of Medicine, Bocage Teaching Hospital, Dijon cedex, France. herve_tixier@yahoo.fr
Grevoul
Julie
J
Loffroy
Romaric
R
Lauferon
Juliette
J
Guiu
Boris
B
Mutamba
William
W
Filipuzzi
Laurence
L
Cercueil
Jean Pierre
JP
Douvier
Serge
S
Krause
Denis
D
Sagot
Paul
P
D000328:Adult; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000601:surgery / Q000628:therapy*; D008026:Ligation; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055988:Uterine Artery / Q000601:surgery*; D055357:Uterine Artery Embolization; D014594:Uterine Neoplasms / Q000601:surgery / Q000628:therapy*