Uterine fibroids are the most common benign tumors of the female genital tract, with an
estimated incidence of 25-80% during the reproductive period in the general population.
If the affected patients do not usually have any symptoms, uterine fibroids may also,
depending on their location, be responsible for acute and chronic pelvic pain, bleeding and
infertility.
Symptomatic uterine fibroids are now treated in the first line by surgery (hysterectomy,
laparotomy myomectomy, laparoscopy or hysteroscopy). When conservative treatment is indicated
and the fibroid is not hysteroscopically accessible, myomectomy can be performed by
laparotomy or laparoscopy.
Excision of myomas often richly vascularized exposes the surgeon and the patient to a risk of
bleeding per- and / or post-operative sometimes severe, resulting in an increase in operating
times, an increased risk of postoperative complications and need transfusion.
The literature is rather poor on this subject but some factors favoring bleeding have been
identified: the history of myomectomy, a uterine volume equivalent to more than 20 weeks of
amenorrhea, the excision of more than 10 fibroids, or an incisional approach.
In order to reduce these intraoperative bleeds, numerous therapeutic strategies have been
developed, using drug alternatives (GnRH agonists, Ullipristal) or interventional radiology
(embolisation of the uterine arteries).
The improvement of interdisciplinary collaboration is now seeing the emergence of numerous
therapeutic strategies combined.
The effectiveness of uterine artery embolization has been demonstrated for several years in
the treatment of fibroids, alone or in combination with surgical myomectomy.
Some studies on preoperative embolization (maximum 24 hours before the intervention) have
shown encouraging results with regard to the volume of bleeding, the need for per or
post-operative transfusion or the need for surgical revision, or even decision to
hystérectomie.
In 2011, Butori et al. propose the use of absorbable spongy particles (Curaspon type) for
preoperative embolization. The use of these resorbable particles would reduce the risk of
postoperative synechia. Some studies indicate that embolization of the uterine arteries using
non-absorbable material would be responsible for ovarian failure by hypo-infusion. The use of
absorbable material would avoid this adverse effect while preserving its effectiveness for
the surgical procedure, but to date no study clearly demonstrates this.
This retrospective case-control study aims to compare the occurrence of per-and
post-operative adverse effects between a test group consisting of patients who had undergone
preoperative embolization (with resorbable material) before myomectomy (intervention group)
and a control group with myomectomy without embolization (control group).
