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Misoprostol vs vasopressin as a single hemostatic agent in laparoscopic myomectomy: Comparable, or just better than nothing?
Author(s) -
Protopapas Athanasios,
Kathopoulis Nikolaos,
Chatzipapas Ioannis,
Athanasiou Stavros,
Grigoriadis Themistoklis,
Samartzis Konstantinos,
Kypriotis Konstantinos,
Vlachos DimitriosEythymios,
Zacharakis Dimitrios,
Loutradis Dimitrios
Publication year - 2020
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/jog.14465
Subject(s) - medicine , misoprostol , blood loss , vasopressin , laparoscopy , adverse effect , hemostatic agent , surgery , oxytocin , hemostasis , anesthesia , saline , pregnancy , genetics , abortion , biology
Abstract Aim Laparoscopic myomectomy may be associated with considerable blood loss, especially in patients in whom no specific hemostatic measures are used. We conducted this retrospective comparative study to investigate whether misoprosol is an effective and safe alternative to vasopressin when used as single hemostatic agent in laparoscopic myomectomy. Methods Two hundred cases undergoing laparoscopic myomectomy (‐ies), were included. Of these, 50 pre‐treated with vaginal misoprostol 400mcg 1 h before surgery (group 1), were compared with two historic consecutive groups: 100 patients treated with intraoperative intra‐myometrial injection of dilute vasopressin (20 IU/100 mL normal saline) (group 2), and 50 treated without use of any hemostatic agent (group3). Results Mean procedure length did not differ significantly between the three groups (127.9 vs 100.6 vs 130.8 min). Mean estimated blood loss (EBL) was 179.7 ± 200.0 mL in group 1, compared with 147.8 ± 171.8 mL in group 2 ( P = 0.793) and 321.8 ± 246.0 mL in group 3, respectively ( P < 0.001). EBL was lower in group 2 in most of the study's subgroups of patients stratified according to size and number of fibroids compared with group 1, with the exception of patients with ≥4 fibroids, and ≥7 cm in size. In these subgroups, misoprostol appeared more effective. Neither agent was associated with serious adverse events. Conclusion Vaginal misoprostol can be effective in reducing blood loss during laparoscopic myomectomy. Although rates of EBL are, in general, higher compared with those obtained with vasopressin, they are significantly reduced compared with those observed when no hemostatic agent is used. In extended procedures, vaginal misoprostol, due to its prolonged uterotonic action, may be associated with reduced blood loss compared with vasopressin.