TITLE:
Contribution of the Tourniquet in the Prevention of Haemorrhages during Myomectomies at the University Hospital of Brazzaville
AUTHORS:
C. Itoua, E. M. L. Eouani, F. S. Okoko Ambeto, N. S. B. Potokoué Mpia, N. S. B. Potokoué Mpia, P. S. Koko, F. O. Atipo-Tsiba Galiba, L. H. Iloki
KEYWORDS:
Tourniquet, Myoma, Myomectomies, Prevention, Haemorrhage, Cost, Brazzaville, Congo
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.8 No.8,
July
5,
2018
ABSTRACT: Objective: To check the effectiveness of tourniquet in the
prevention of haemorrhage during myomectomies at the University Hospital of
Brazzaville. Patients and methods: Analytical cross-sectional study,
conducted at the University Hospital of Brazzaville from June 1, 2014 to June
30, 2016. Recruitment was performed by randomly matching each case of
myomectomy performed using a tourniquet with two cases of myomectomy without
tourniquet (50 cases vs 100 witnesses). We used as a tourniquet, the surgical
glove knotted and tightened sufficiently at the level of the isthmus of the
uterus to temporarily occlude the uterine arteries to ensure haemostasis
lasting no more than one hour. Results: The mean age of the patients was
similar in both groups (36, 1 ± 2.2 years vs 36.2 ± 1.9 years, P > 0.05). Menorrhagia was the most common
indication of myomectomy in both groups (76% vs. 78% P > 0.05). The mean haemoglobin
level of the patients before the myomectomies was 9.03 ± 1.10 g/dl vs 9, 75 ± 1.29 g/dl; P > 0.05. Intraoperative uterine features were
similar in size (18 weeks gestation, 14 - 24) and number of myomas (5 vs 4, P > 0.05) in both groups. Polymyomectomy was more
common in both groups (76% vs 73%, P > 0.05). Blood loss was reduced in the tourniquet
group (90.5 ± 4.6 ml vs 200.4 ± 5.6 ml; P 0.05), as well as the use of blood transfusion (8%
vs 50%, P 0.05). Use of the number of sutures was reduced in
the group with tourniquet (3 ± 0.2 vs 6 ± 0.2 P 0.05). The duration of the procedure was shorter in
the group with tourniquet (51.5 ± 4 min vs 83 ± 7 min, P 0.05). Postoperative mean haemoglobin of patients
was no different between the two groups (9.4 ± 0.7 g/dl vs 9.2 ± 0.5, P > 0.05). The overall cost of management was
reduced in the group with tourniquet (190,680 ± 1450 F CFA vs 256,800 ± 2350 FCFA; P 0.05). Conclusion: The use of tourniquet
during myomectomies significantly reduces blood loss and the use of blood
transfusion. We also obtain the notorious reduction in the use of sutures, the
duration of interventions, and the overall cost of care. Thus, we encourage the
systematic use of tourniquet during myomectomies by laparotomy.