Surgical outcomes after uterine artery occlusion at the time of myomectomy: systematic review and meta-analysis

Objective: To systematically review andmeta-analyze evidence on surgical outcomes after uterine artery occlusion (UAO) atmyomectomy. Design: Systematic review and meta-analysis. Setting: Not applicable. Patient(s): Twenty-six studies involving 2,871 patients located via database searches of MEDLINE, Embase, Web of Science, PubMed, clinicaltrials.gov, and cited references. Intervention(s): Intervention groups undergoing UAO at laparoscopic or abdominal myomectomy (UAOthornM) (1,569 patients), and control groups undergoing myomectomy alone (1,302 patients). Main Outcome Measure(s): Primary outcome of surgical blood loss (estimated blood loss, transfusion rate, and change in hemoglobin values), and secondary outcomes including operative time, length of stay, conversion and complications rates, fibroid recurrence, and changes in fibroid-related symptoms. Result(s): The patients undergoing UAO+M had a statistically significant reduction in estimated blood loss (mean difference [MD] - 103.7 mL; 95% confidence interval [CI], - 126.5 to -80.8), blood transfusion (relative risk [RR] 0.24; 95% CI, 0.15-0.39), and change in hemoglobin values (MD - 0.60 g/dL; 95% CI, - 0.79 to - 0.40) compared with controls. Using UAO+M prolonged operative times (MD 10.9 minutes; 95% CI, 3.5-18.2) but shortened the length of stay (MD - 0.37 days; 95% CI, - 0.62-0.11).Using UAO+M lowered the complication rates (RR 0.73; 95% CI, 0.52-1.00) to the threshold of statistical significance and reduced the risk of fibroid recurrence (RR 0.36; 95% CI, 0.16-0.83) compared with controls. Conclusion(s): Uterine artery occlusion at myomectomy is associated with decreased surgical blood loss and transfusion rate compared with control patients. However, further research is required on reproductive outcomes and the effect on ovarian reserve before routine use can be recommended in women desiring future fertility. (C) 2018 by American Society for Reproductive Medicine.