Review Outlines Diverse Pre- and Intraoperative Strategies to Minimize Blood Loss in Open Myomectomy

Uterine leiomyomas, commonly known as fibroids, are benign smooth muscle tumors affecting a significant portion of women, with a lifetime incidence of approximately 70%. While many are asymptomatic, 20-40% of women experience debilitating symptoms such as abnormal uterine bleeding, dysmenorrhea, and pelvic pain. The standard surgical treatment, abdominal myomectomy, often faces the challenge of substantial intraoperative blood loss, typically ranging from 200 to 800 ml. This can complicate the procedure, sometimes necessitating conversion to hysterectomy due to uncontrollable hemorrhage or inability to reconstruct the uterus.

This paper reviews and synthesizes various established and emerging methods aimed at reducing blood loss during open myomectomy. It categorizes these strategies into preoperative interventions, intraoperative techniques, and vascular interventions. The discussion covers approaches from systemic patient preparation to direct surgical and pharmacological measures, highlighting their roles in mitigating hemorrhage. The review aims to provide an overview of the diverse toolkit available to surgeons to improve patient outcomes and reduce the risk of complications associated with excessive bleeding.

The review identifies a range of strategies to manage bleeding during myomectomy. Preoperative measures include correcting anemia with iron supplementation and using gonadotropin-releasing hormone (GnRH) triggers to reduce fibroid size and vascularity prior to surgery. Intraoperative techniques are diverse, encompassing mechanical methods such as applying a tourniquet around the uterus to temporarily occlude blood flow. Pharmacological interventions include direct uterine muscle injections of vasopressors like Vasopressin or epinephrine, which induce vasoconstriction to reduce local blood supply. Additionally, ecbolic agents such as misoprostol, oxytocin, and carbetocin are employed to stimulate strong myometrial contractions, thereby occluding vessels supplying the leiomyomas. > Vascular interventions, such as uterine artery ligation, embolization, or internal iliac artery ligation, are also discussed as critical options to prevent or manage heavy bleeding, potentially avoiding intraoperative conversion to hysterectomy. These methods collectively aim to reduce the average blood loss, which can be 200 to 800 ml, making the procedure safer and more feasible.