MANAGING INTRAOPERATIVE BLEEDING IN MYOMECTOMY: A REVIEW OF SURGICAL APPROACHES

Uterine leiomyomas, commonly known as fibroids, are the most prevalent benign tumors in women of reproductive age, with a lifetime incidence of approximately 70%. While most myomas are asymptomatic, 20–40% of affected women experience significant clinical symptoms, including abnormal uterine bleeding, dysmenorrhea, pelvic pain, infertility, and recurrent pregnancy loss. Management strategies vary depending on symptom severity and reproductive desires. Hysterectomy remains the definitive treatment for women who have completed childbearing, whereas myomectomy is the preferred uterus-sparing option for those wishing to preserve fertility. Myomectomy can be performed via laparotomy, laparoscopy, or hysteroscopy and involves the surgical excision of fibroids with uterine reconstruction. However, the procedure carries inherent risks, the most significant being perioperative hemorrhage, which may sometimes necessitate conversion to hysterectomy. The risk of blood loss is influenced by fibroid number, size, and location. This study evaluates various surgical techniques and strategies aimed at minimizing hemorrhage during myomectomy, highlighting approaches that enhance patient safety, preserve fertility, and optimize surgical outcomes.