TOURNIQUET USE OR NOT USE IN MYOMECTOMY: AN EXPERIENCE AT SAHIWAL TEACHING HOSPITAL, A RETROSPECTIVE CROSS SECTIONAL STUDY

Abstract

Objectives: To evaluate the effectiveness of Tornique use or not use in open Myomectomy and Its Complications
Methods: This is a retrospective, single centred cross-sectional study, a retrospective review of cases of abdominal myomectomy between June 2018 and June 2024. Data were obtained from ward and operating theatre case records. Records of 172 Patients were reviewed and separated in two groups on the basis of tourniquet use or not use. In Group A, 76 patients, a Foley catheter was used as a tourniquet to temporarily limit blood flow from the uterine vessels. The tourniquet was not released intermittently as it was applied at the uterine artery level and was removed after the procedure. In Group B, 96 patients, myomectomies were performed without a tourniquet. Blood loss estimation and intraoperative blood transfusion recorded. In all cases, the histological diagnosis was a leiomyoma. Age in years, BMI, duration of symptoms, size of largest Myoma. Number of Myomas Complications like intraoperative blood loss, postpartum pyrexia, urinary tract infection, wound infection and injury to gut and urinary bladder between the two groups.
Results: Total records of172 patients were selected. In 76 patients, Torniquet was used, in 96 Torniquet was not used. Most patients in the dataset were around 30 years old, with their symptoms lasting approximately 8.8 months. The average size of the leiomyomas was around 6.7 cm, with patients typically having around 2 leiomyomas. On average, patients have a BMI of 26.36, indicating an overweight population. The majority of patients do not have hypertension or diabetes. Significant difference p value <0.05 in intraoperative blood loss and intrauterine blood transfusion between two groups (p = 0.005), less blood loss when the tourniquet is used. Independent T test was used to compare differences in the duration of surgery in minutes and hospital stay in days between the two groups. The use of a tourniquet significantly reduced the length of surgery by an average of 7.03 minutes (p = .000). Patients who had a tourniquet used had a significantly shorter hospital stay, averaging 0.91 days less (p = .000). No significant differences for urinary tract infection, wound infection, postop pyrexia or injury to the gut/urinary bladder between the groups. p value >0.05.

Conclusion: Fibroids can occur any time in the reproductive age group with more BMIs, sizes and numbers. Tourniquet use is significantly associated with less intraoperative blood loss and blood transfusion, with no significant differences for urinary tract infection, wound infection, or injury to the gut/urinary bladder between the two groups. This analysis indicates that the use of a tourniquet during surgery is associated with shorter surgery durations and hospital stays.