Background and Objectives: A tourniquet has been suggested as a useful means of reducing massive hemorrhage during myomectomy. However, it is not clear whether the restricted perfusion affects the ovaries. In the present study, we examined the effect of a tourniquet on ovarian reserve and blood loss during myomectomy. Materials and Methods: In a randomized double-blind clinical trial, fertile nonobese patients scheduled for abdominal myomectomy at Rasool-e-Akram Hospital from February 2018 to June 2019 were randomized to a tourniquet (n = 46) or a non-tourniquet group (n = 35). Serum levels of anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH) were measured before and 3 months after surgery, blood loss was recorded during surgery, and serum levels of hemoglobin (Hb) were recorded before surgery, 6 h and 3 days after surgery. SPSS version 21 was used for statistical analysis. Results: Demographic, obstetric, and myoma characteristics were similar in the 2 groups (p > 0.05). The mean baseline values of AMH and FSH did not differ between groups (p > 0.05). After surgery, only FSH was higher in the control group (p = 0.043). Despite the time taken to fasten and open the tourniquet, the mean operating time was shorter in the tourniquet group (p < 0.001). Blood loss was higher in the control group (p = 0.005). The drop in Hb levels at 6 h after surgery was higher in the non-tourniquet group (p = 0.002). Blood loss was significantly associated with the duration of surgery (r = 0.523, p < 0.001). Conclusion: The use of a tourniquet during abdominal myomectomy significantly reduced the mean volume of blood loss compared to the non-tourniquet group, while it did not prolong the duration of surgery, nor reduced the ovarian reserve. A tourniquet is a safe and efficient measure during abdominal myomectomy.

1.
Stewart
EA
,
Cookson
CL
,
Gandolfo
RA
,
Schulze-Rath
R
.
Epidemiology of uterine fibroids: a systematic review
.
BJOG
.
2017 Sep
;
124
(
10
):
1501
12
.
2.
Williams
ARW
.
Uterine fibroids: what’s new?
F1000Res
.
2017
;
6
:
2109
16
.
3.
Vitale
SG
,
Sapia
F
,
Rapisarda
AMC
,
Valenti
G
,
Santangelo
F
,
Rossetti
D
, et al
Hysteroscopic morcellation of submucous myomas: a systematic review
.
Biomed Res Int
.
2017
;
2017
:
6848250
.
4.
Laganà
AS
,
Vergara
D
,
Favilli
A
,
La Rosa
VL
,
Tinelli
A
,
Gerli
S
, et al
Epigenetic and genetic landscape of uterine leiomyomas: a current view over a common gynecological disease
.
Arch Gynecol Obstet
.
2017 Nov
;
296
(
5
):
855
67
.
5.
Fichera
M
,
Török
P
,
Tesarik
J
,
Della Corte
L
,
Rizzo
G
,
Garzon
S
, et al
Vitamin D, reproductive disorders and assisted reproduction: evidences and perspectives
.
Int J Food Sci Nutr
.
2020 May
;
71
(
3
):
276
85
.
6.
Vitagliano
A
,
Noventa
M
,
Di Spiezio Sardo
A
,
Saccone
G
,
Gizzo
S
,
Borgato
S
, et al
Uterine fibroid size modifications during pregnancy and puerperium: evidence from the first systematic review of literature
.
Arch Gynecol Obstet
.
2018 Apr
;
297
(
4
):
823
35
.
7.
Franchi
M
,
Raffaelli
R
,
Baggio
S
,
Scollo
M
,
Garzon
S
,
Laganà
AS
, et al
Unintentional transvesical caesarean section: incidence, risk factors, surgical technique and post-operative management
.
Eur J Obstet Gynecol Reprod Biol
.
2019 May
;
236
:
26
31
.
8.
Alkatout
I
,
Mettler
L
,
Günther
V
,
Maass
N
,
Eckmann-Scholz
C
,
Elessawy
M
, et al
Safety and economical innovations regarding surgical treatment of fibroids
.
Minim Invasive Ther Allied Technol
.
2016 Dec
;
25
(
6
):
301
13
.
9.
Singh
SS
,
Belland
L
.
Contemporary management of uterine fibroids: focus on emerging medical treatments
.
Curr Med Res Opin
.
2015 Jan
;
31
(
1
):
1
12
.
10.
Ukybassova
T
,
Terzic
M
,
Dotlic
J
,
Imankulova
B
,
Terzic
S
,
Shauyen
F
, et al
Evaluation of uterine artery embolization on myoma shrinkage: results from a large cohort analysis
.
Gynecol Minim Invasive Ther
.
2019 Oct–Dec
;
8
(
4
):
165
71
.
11.
Vilos
GA
,
Allaire
C
,
Laberge
PY
,
Leyland
N
.
The management of uterine leiomyomas
.
J Obstet Gynaecol Can
.
2015 Feb
;
37
(
2
):
157
78
.
12.
Laganà
AS
,
Vitale
SG
,
Muscia
V
,
Rossetti
P
,
Buscema
M
,
Triolo
O
, et al
Endometrial preparation with dienogest before hysteroscopic surgery: a systematic review
.
Arch Gynecol Obstet
.
2017 Mar
;
295
(
3
):
661
7
.
13.
Laganà
AS
,
Giacobbe
V
,
Triolo
O
,
Granese
R
,
Ban Frangež
H
,
Vrtačnik-Bokal
E
, et al
Dienogest as preoperative treatment of submucous myomas for hysteroscopic surgery: a prospective, randomized study
.
Gynecol Endocrinol
.
2016
;
32
(
5
):
408
11
.
14.
Mas
A
,
Tarazona
M
,
Dasí Carrasco
J
,
Estaca
G
,
Cristóbal
I
,
Monleón
J
.
Updated approaches for management of uterine fibroids
.
Int J Womens Health
.
2017
;
9
:
607
17
.
15.
Donnez
J
,
Dolmans
MM
.
Uterine fibroid management: from the present to the future
.
Hum Reprod Update
.
2016
;
22
(
6
):
665
86
.
16.
Khazaei
S
,
Soheylizad
M
,
Veisani
Y
,
Rezaeian
S
,
Biderafsh
A
,
Ahmadi-Pishkuhi
M
, et al
Global inequality in the incidence and mortality rates of esophageal cancer: a country-level analysis
.
Int J Cancer Manag
.
2018
;
11
(
5
).
17.
Laganà
AS
,
Alonso Pacheco
L
,
Tinelli
A
,
Haimovich
S
,
Carugno
J
,
Ghezzi
F
, et al
Management of asymptomatic submucous myomas in women of reproductive age: a consensus statement from the global congress on hysteroscopy scientific committee
.
J Minim Invasive Gynecol
.
2019 Mar– Apr
;
26
(
3
):
381
3
.
18.
Alkatout
İ
,
Mettler
L
.
Hysterectomy A comprehensive surgical approach
.
J Turk Ger Gynecol Assoc
.
2017 Dec 15
;
18
(
4
):
221
3
.
19.
Paul
GP
,
Naik
SA
,
Madhu
KN
,
Thomas
T
.
Complications of laparoscopic myomectomy: a single surgeon’s series of 1001 cases
.
Aust N Z J Obstet Gynaecol
.
2010
;
50
(
4
):
385
90
.
20.
Faes
T
,
Housmans
S
,
Deprest
J
,
Verguts
J
.
Myomectomy: surgical techniques anno 2018. A systematic review
.
Int J Surg Proced
.
2018
;
1
(
3
):
112
.
21.
Conforti
A
,
Mollo
A
,
Alviggi
C
,
Tsimpanakos
I
,
Strina
I
,
Magos
A
, et al
Techniques to reduce blood loss during open myomectomy: a qualitative review of literature
.
Eur J Obstet Gynecol Reprod Biol
.
2015 Sep
;
192
:
90
5
.
22.
Fanny
M
,
Fomba
M
,
Aka
E
,
Adjoussou
S
,
Olou
L
,
Koffi
A
, et al
[Prevention of bleeding during laparotomic myomectomy in Sub-Saharan Africa: contribution to the tourniquet on the uterine isthmus]
.
Gynecol Obstet Fertil Senol
.
2018 Nov
;
46
(
10–11
):
681
5
.
Prevention de l’hemorragie per myomectomie en Afrique subsaharienne : apport du garrot sur l’isthme uterin. fre
.
23.
Alptekin
H
,
Efe
D
.
Effectiveness of pericervical tourniquet by Foley catheter reducing blood loss at abdominal myomectomy
.
Clin Exp Obstet Gynecol
.
2014
;
41
(
4
):
440
4
.
24.
Helal
AS
,
Abdel-Hady
El-S
,
Refaie
E
,
El Shamy
M
,
El Fattah
RA
,
Mashaly
AM
.
Preliminary uterine artery ligation versus pericervical mechanical tourniquet in reducing hemorrhage during abdominal myomectomy
.
Int J Gynaecol Obstet
.
2010 Mar
;
108
(
3
):
233
5
.
25.
Al
RA
,
Yapca
OE
,
Gumusburun
N
.
A randomized trial comparing triple versus single uterine tourniquet in open myomectomy
.
Gynecol Obstet Invest
.
2017
;
82
(
6
):
547
52
.
26.
Ikechebelu
JI
,
Ezeama
CO
,
Obiechina
NJ
.
The use of torniquet to reduce blood loss at myomectomy
.
Niger J Clin Pract
.
2010 Jun
;
13
(
2
):
154
8
.
27.
Nelson
SM
.
Biomarkers of ovarian response: current and future applications
.
Fertil Steril
.
2013
;
99
(
4
):
963
9
.
28.
Kongnyuy
EJ
,
Wiysonge
CS
.
Interventions to reduce haemorrhage during myomectomy for fibroids
.
Cochrane Database Syst Rev
.
2011 Nov 9
;(
11
):
CD005355
.
29.
Kim
CW
,
Shim
HS
,
Jang
H
,
Song
YG
.
The effects of uterine artery embolization on ovarian reserve
.
Eur J Obstet Gynecol Reprod Biol
.
2016 Nov
;
206
:
172
6
.
30.
Sanders
AP
,
Norris
S
,
Tulandi
T
,
Murji
A
.
Reproductive outcomes following uterine artery occlusion at the time of myomectomy: systematic review and meta-analysis
.
J Obstet Gynaecol Can
.
2020 Jun
;
46
(
6
):
787
97.e2
.
31.
Verit
FF
,
Çetin
O
,
Keskin
S
,
Akyol
H
,
Zebitay
AG
.
Does bilateral uterine artery ligation have negative effects on ovarian reserve markers and ovarian artery blood flow in women with postpartum hemorrhage?
Clin Exp Reprod Med
.
2019
;
46
(
1
):
30
5
.
32.
Taylor
A
,
Sharma
M
,
Tsirkas
P
,
Di Spiezio Sardo
A
,
Setchell
M
,
Magos
A
.
Reducing blood loss at open myomectomy using triple tourniquets: a randomised controlled trial
.
BJOG
.
2005
;
112
(
3
):
340
5
.
33.
Afolabi
MA
,
Ezeoke
GG
,
Saidu
R
,
Ijaiya
MA
,
Adeniran
AS
.
Comparing perioperative vaginal misoprostol with intraoperative pericervical hemostatic tourniquet in reducing blood loss during abdominal myomectomy: a randomized controlled trial
.
J Turk Ger Gynecol Assoc
.
2019
;
20
(
1
):
23
30
.
34.
Ginsburg
ES
,
Benson
CB
,
Garfield
JM
,
Gleason
RE
,
Friedman
AJ
.
The effect of operative technique and uterine size on blood loss during myomectomy: a prospective randomized study
.
Fertil Steril
.
1993
;
60
(
6
):
956
62
.
35.
Garzon
S
,
Laganà
AS
,
Pomini
P
,
Raffaelli
R
,
Ghezzi
F
,
Franchi
M
.
Laparoscopic reversible occlusion of uterine arteries and cornuostomy for advanced interstitial pregnancy
.
Minimally Invasive Ther Allied Tech
.
2019 Dec
;
28
(
6
):
359
62
.
36.
Sanyal
U
,
Ghosh
S
,
Hiremath
P
,
Hiremath
R
.
The role of tourniquet in myomectomy: an observational study
.
Int J Reprod Contracept Obstet Gynecol
.
2019
;
8
(
4
):
1611
.
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