Bilateral Uterine Artery Ligation: An Effective Low-Technology Option in the Management of Symptomatic Uterine Fibroids

Abstract

Objective: This pilot study was designed to determine the efficacy of uterine artery ligation by the vaginal route as a low-technology alternative to uterine artery embolisation in the management of symptomatic uterine fibroids.


Methods: Both nulliparous and multiparous women who had symptoms of uterine leiomyomata such as menorrhagia, dysmenorrhoea and abdominal swelling were informed about a new approach for the treatment of fibroids and, after giving consent, were recruited for the study. Ultrasonic measurements of uterine and fibroid volumes were determined pre-operatively and at two, six, twelve and eighteen weeks after the procedure. The severity of menorrhagia, dysmenorrhoea and pelvic pain were documented pre-and post-operatively. All the patients had bilateral uterine artery ligation using the vaginal route.


Results: Ten patients aged between 31 and 49 years of age were studied. The mean duration of surgery was 64 minutes. Mean duration of hospital stay was 48 hours. Mean estimated intraoperative blood loss was 262 millilitres. A 20.5% reduction in mean uterine volume was noted at six and twelve weeks post-surgery. The mean duration of menstrual flow was reduced from 23 days before surgery to 17.3 days at the immediate next cycle postoperatively. Subsequently, most patients noted more reductions, although one had a rebound increase. All patients had reduction in perceived pelvic pain and an improved sense of well-being.


Conclusion: It is suggested that the favourable results documented from studies using uterine artery embolisation can be replicated using uterine artery ligation, which is a low-technology alternative. This is an ongoing study.


Key Words: Uterus, Leiomyoma, Menstrual Loss, Artery Ligation.


[Trop J Obstet Gynaecol, 2003, 20: 4-6]