Technique to reduce blood loss during open abdominal myomectomy: transverse or vertical incision?

Uzunlar, Ozlem; Ibanoglu, Mujde Can; Kaplan, Asli

doi:10.1590/1806-9282.20200880

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Revista da Associação Médica Brasileira

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ORIGINAL ARTICLE • Rev. Assoc. Med. Bras. 67 (3) • Mar 2021 • https://doi.org/10.1590/1806-9282.20200880 copy

Technique to reduce blood loss during open abdominal myomectomy: transverse or vertical incision?

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

To determine if there is a difference between uterine incision techniques (vertical vs. transversal) in terms of clinical results.

METHODS:

All women with leiomyomas who underwent open abdominal myomectomy (n=61) between March and August 2016 at the Gynecology and Obstetrics Clinic at the Women’s Health Research and Training Hospital Zekai Tahir Burak were included, and the clinical results were included and prospectively reviewed.

RESULTS:

The estimated blood loss during myomectomy increased in the transversal group compared with the vertical group (809.33±483.34 versus 405.32±180.95 mL, p<0.001). The average operation duration was 60 min, and the patients got discharged on the second day after surgery. No intergroup statistical differences were observed in the surgical procedure.

CONCLUSIONS:

Surgeons should give preference to the most viable incision depending on the size and location of the leiomyoma.

KEYWORDS:
Gynecologic surgical procedures; Uterine myomectomy; Safety; Ergonomics

	Vertical incision group (n=31)	Transverse incision group (n=30)	p-value
Age, years (median, range)	39(26–45)	37.5(25–44)	0.058
Parity (median, range)	2(0–3)	2(0–5)	0.887
Mean myoma diameter, cm (median, range)	8(5–15)	8(4–13)	0.351
Number of leiomyomas (median, range)	1(1–4)	1(1–6)	0.010
Uterine size, cm (median, range)	12(8–18)	12(8–20)	0.485
Chronic pelvic pain	17 (54.8)	15 (50)	0.903
Menorrhagia	22 (71)	18 (60)	0.528
Location of myomas (n, %)
Anterior	12 (38.7)	16 (53.3)	0.374
Posterior	16 (51.6)	14 (46.7)	0.896
Fundal	5 (16.1)	6 (20)	0.952
Operation duration (min)	60(45–180)	60(40–200)	0.344
Blood loss (mL)	400(170–850)	745(170–2200)	<0.001
Hospital stay duration (days)	2(2–4)	2(1–7)	0.329

		Vertical incision group (mean±standard deviation)	Transverse incision group (mean±standard deviation)	p-value
Hemoglobin levels (g/dL)	Preoperative	11.95±1.62	11.65±1.32	0.434
	Postoperative 2nd hour	11.13±1.54	10.36±1.54	0.056
	Postoperative 6th hour	10.98±1.60	10.49±1.43	0.211
Operation duration (min)		60(45–180)	60(40–200)	0.344
Blood loss (mL)		405.32(170–850)	809.33(170–2200)	<0.001
Hospital stay duration (days)		2(2–4)	2(1–7)	0.329

		Vertical incision group (mean±standard deviation)	p-value	Transverse incision group (mean±standard deviation)	p-value
Hemoglobin Levels (g/dL)	Difference between preoperative and postoperative 2nd hour	0.82±1.25	<0.001	1.29±0.81	<0.001
	Difference between preoperative and postoperative 6th hour	0.97±1.26	<0.001	1.16±0.86	<0.001
	Difference between postoperative 2nd hour and 6th hour	0.15±0.57	0.249	−0.12±0.88	0.365

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[1] * Corresponding author: drmujdecan@gmail.com