Purpose: To evaluate the efficacy of pre-myomectomy uterine artery embolization with gelatin sponge particles to reduce operative blood loss and facilitate removal of fibroids.Materials and methods: This retrospective study included 33 women (mean age, 36 years; range, 24-45 years), of whom at least 18 wished to preserve fertility. They presented with at least one large myoma (mean diameter, 90mm; range, 50-150 mm) and had undergone preoperative uterine artery embolization with resorbable gelatin sponge by unilateral femoral approach between December 2001 and November 2008. Clinical, radiological and surgical data were available for all patients. Mean haemoglobin levels before and after surgery were compared with Student's t-test.Results: No complication or technical failure of embolization occurred. The myomectomies were performed during laparotomy (25 cases) or laparoscopy (8 cases). Dissection of fibroids was easier (mean, 3 per patient; range, 1-11), with a mean operating time of 108 +/- 50 min (range, 30-260 min). Bloodless surgery was the rule with a mean estimated peroperative blood loss of 147 +/- 249 mL (range, 0-800 mL). Mean pre-(12.9 +/- 1.3 g/dL) and post-therapeutic (11.4 +/- 1.2 g/dL) haemoglobin levels were not statistically different (p > 0.05). There was no need for blood transfusion. None of the patients required hysterectomy. The mean duration of hospital stay was 7.5 perpendicular to 1.3 days (range, 3-12 days).Conclusion: Preoperative uterine artery embolization is effective in reducing intraoperative blood loss and improves the chances of performing conservative surgery. It should be considered a useful adjunct to myomectomy in women at high hemorrhagic risk or who refuse blood transfusion. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

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.

PURPOSE:Fibroids are a frequent cause of gynecology referral. Myomectomy is a conservative treatment alternative. The main risk from this procedure is hemorrhage. The main objective of this study was to demonstrate the efficacy of preoperative uterine artery embolization with resorbable agents to reduce blood losses and facilitate myomectomy. Secondary objectives were to evaluate morbidity and subsequent fertility.PATIENTS AND METHODS:Retrospective study of 21 patients with preoperative uterine artery embolization prior to myomectomy at the University Medical Center of Dijon over a 3 year period.RESULTS:Myomectomy after uterine artery embolization with resorbable agents was associated with only minimal blood loss. Mean preoperative and postoperative hemoglobin levels were comparable (p<0.0001). Uterine suturing was technically simpler. The number of resected fibroids (p=0.2824) and the presence of preoperative anemia (p=0.474) had no statistically significant impact on the duration of hospital stay. Uterine synechiae occurred in three patients after the procedure, and were easily treated. Two patients had normal subsequent pregnancies.CONCLUSION:Preoperative uterine artery embolization with resorbable agents was effective in reducing surgical blood losses. This technique reduces the number of hysterectomies and hemorrhagic complications (hematoma, infection, weaker scar tissue). It should be considered in patients wishing uterine preservation when the hemorrhagic risk is high. Its use in patients seeking subsequent pregnancy should be further assessed with larger series.

Fibroids are a frequent cause of gynecology referral. Myomectomy is a conservative treatment alternative. The main risk from this procedure is hemorrhage. The main objective of this study was to demonstrate the efficacy of preoperative uterine artery embolization with resorbable agents to reduce blood losses and facilitate myomectomy. Secondary objectives were to evaluate morbidity and subsequent fertility. Retrospective study of 21 patients with preoperative uterine artery embolization prior to myomectomy at the University Medical Center of Dijon over a 3 year period. Myomectomy after uterine artery embolization with resorbable agents was associated with only minimal blood loss. Mean preoperative and postoperative hemoglobin levels were comparable (p<0.0001). Uterine suturing was technically simpler. The number of resected fibroids (p=0.2824) and the presence of preoperative anemia (p=0.474) had no statistically significant impact on the duration of hospital stay. Uterine synechiae occurred in three patients after the procedure, and were easily treated. Two patients had normal subsequent pregnancies. Preoperative uterine artery embolization with resorbable agents was effective in reducing surgical blood losses. This technique reduces the number of hysterectomies and hemorrhagic complications (hematoma, infection, weaker scar tissue). It should be considered in patients wishing uterine preservation when the hemorrhagic risk is high. Its use in patients seeking subsequent pregnancy should be further assessed with larger series. Les fibromes représentent une cause fréquente de consultation en gynécologie. La myomectomie est une alternative thérapeutique conservatrice. Le principal risque de cette intervention tient à son caractère hémorragique. L’objectif principal de cette étude est de montrer l’efficacité de l’embolisation transitoire des artères utérines pour diminuer les pertes sanguines et simplifier la myomectomie. Les objectifs secondaires sont d’évaluer la morbidité et la fertilité ultérieure. Il s’agit d’une étude rétrospective descriptive de vingt et un cas d’embolisation utérine avant myomectomie sur une période de 3 ans au Centre Hospitalier Universitaire de Dijon. La myomectomie après embolisation avec du matériel résorbable est quasiment exsangue. Les moyennes des taux d’hémoglobine en pré et postopératoire sont comparables (p < 0,0001). La suture utérine est techniquement plus simple. Le nombre de fibromes retirés (p = 0,2824) et la présence d’une anémie avant l’intervention (p = 0,474) ne modifient pas de manière statistiquement significative la durée d’hospitalisation. Trois patientes ont présenté des synéchies postopératoires dont la cure a été simple. Deux patientes ont pu mener à terme une grossesse spontanée. L’embolisation transitoire a permis de limiter les saignements. Cette technique mixte diminue le risque d’hystérectomie et les complications liées aux hémorragies (hématome, infection, fragilité de la cicatrice). Elle doit être utilisée chez des patientes qui souhaitent conserver leur utérus lorsque le risque hémorragique est élevé. Son utilisation doit être évaluée de façon très précise chez des patientes désireuses de grossesse, par le biais de séries plus importantes.