Bleeding Control Methods in Open Myomectomy

This prospective randomized controlled trial aims to evaluate the effectiveness of different intraoperative bleeding control techniques during open myomectomy. Uterine leiomyomas are highly vascular tumors, and excessive intraoperative bleeding remains a major challenge, potentially leading to postoperative anemia and increased morbidity.

Various strategies have been developed to reduce intraoperative blood loss, including mechanical and surgical methods aimed at temporarily reducing uterine arterial blood flow. However, most available evidence focuses on minimally invasive approaches, and data regarding open myomectomy remain limited.

In this study, patients undergoing open myomectomy will be randomized into three groups according to the intraoperative bleeding control method: tourniquet application, bilateral uterine artery occlusion using bulldog clamps, and no compression. All procedures will be performed using a standardized surgical technique.

The study aims to compare these techniques in terms of intraoperative blood loss and postoperative hematological parameters.

Inclusion criteria

• Women aged between 18 and 50 years
• Diagnosis of symptomatic uterine leiomyoma
• Planned abdominal (open) myomectomy
• No additional surgical procedure performed during the operation
• Availability of complete preoperative and postoperative laboratory data

Exclusion criteria

• Pregnancy or suspected pregnancy
• Presence of more than 7 myomas
• Suspicion or diagnosis of uterine malignancy
• History of coagulopathy or use of anticoagulant/antiplatelet therapy
• Preoperative blood transfusion
• Concomitant major surgical procedures (e.g., hysterectomy or adnexal surgery)
• History of previous myomectomy
• Incomplete laboratory or clinical data