Preoperative embolization or ligature of the uterine arteries in preparation for conservative uterine fibroma surgery.

OBJECTIVE: To compare the efficacy, feasibility and morbidity of two preparation techniques for conservative uterine myoma surgery: temporary embolization and temporary surgical ligature of the uterine arteries. DESIGN: Retrospective study. SETTING: Gynecological Surgery and Interventional Radiology departments, Centre Hospitalier Universitaire of Dijon, France. POPULATION: A total of 100 women undergoing myomectomy between 2000 and 2008. METHODS: Three groups were constituted: (1) no preparation (43 patients), (2) uterine artery embolization (UAE) (30 patients) and (3) temporary surgical ligature of the uterine arteries (SLUA) (27 patients). The choice of technique depended on the number, size and topography of the fibromas. MAIN OUTCOMES MEASURES: Quantification of peroperative blood loss, delta hemoglobin, complications, subsequent fertility. RESULTS: Blood loss and delta hemoglobin were both lower in group 2 (p = 0.026 and p = 0.0002) and in group 3 (p = 0.048 and p = 0.001), respectively, than in group 1. The two preparation techniques were efficient. SLUA increased the duration of the operation (p < 0.0001). Hospitalization was longer following UAE (p = 0.0001). The rate of complications was 16.3, 23.3 and 3.7%, and of synechiae 9.3, 13.3 and 0% for groups 1, 2 and 3, respectively. The number of pregnancies was 8, 5 and 6 after a mean postoperative period of 5.6, 4.3 and 3.9 years, respectively. CONCLUSION: Both UAE and SLUA for myomectomy are feasible, reproducible and effective techniques for reducing peroperative blood loss. Use of these techniques must be generalized in patients with a high risk of hemorrhage, but may be compatible with subsequent fertility.