Myomectomy under Cervico-Isthmic Tourniquet: Experience ofthe Gynecologic-Obstetric Department at the University TeachingHospital of Cocody (Abidjan)

Abstract

Objective: To report the experience of Cocody’s University Teaching Hospital in the practice of myomectomies under cervico-isthmic tourniquet and to assess its impact on per and post-operative blood loss.
Methodology: It was a case control study covering a 10-year period (that is from January 2009 to December 2018), and a population of 600 patients divided into two groups (A and B). The first (A) includes all patients admitted and operated on uterine myomas after the introduction of a cervico-isthmic tourniquet (CIT) by Foley catheter (case) and the second all patients admitted and operated on without CIT(Control).
Results: The average age of patients was 37 years with extremes of 24 and 50 years They were nulligestous in 38.3% of cases and nulliparous in 61.7% of cases. Hemorrhagic complications made up 65% of the surgical indications. The practice of myomectomy under cervico-isthmic tourniquet was associated with a relatively significant reduction in the duration of intervention including 20 minutes of time saved and a considerable reduction in blood loss(p<0,001). Blood loss was estimated at 438.8 ml (+/- 127) in the CIT group, compared to 685.4 ml (+/- 182) in the control group(p<0,001). The postoperative hemoglobin rate in the cervico-isthmic tourniquet patients was 10.1 g/dl compared to 8.7 g/dl in the non-distort patients(p<0,0012). No complications related to the presence of CIT were observed after sufficient follow-up. The length of stay in the hospital was estimated to be 2.8 days compared to 4.4 days in patients who did not use a tourniquet (p=0,15).
Conclusion: The use of the cervico-isthmic tourniquet in myomectomy, considerably limiting blood loss and reducing postoperative morbidity, appears to be an alternative to blood transfusion in countries of sub-Saharan Africa, where the dispensing of blood products remains a problem.