Myomectomy Details

A myomectomy is a surgical procedure done to remove fibroids within the uterus.  The intent of the surgery is to remove the offending tissue while still preserving the uterus. Fibroids are common noncancerous growths that often grow in the uterus and do not often present with debilitating symptoms. However, when they do, a myomectomy is the best option to reduce them. Some symptoms that patients may complain of that caused by fibroids are: lower back pain, pain during intercourse, heavy menstrual bleeding, and pelvic pressure. A myomectomy may also be performed to increase chances of pregnancy. 

Before Myomectomy

Women with fibroids do not always need them removed because they are not usually symptom-causing. Patients who are considering myomectomies are usually presenting with symptoms of pain, abnormal bleeding, or reproduction difficulties.  Patients should consult with their doctor to determine whether a myomectomy is needed or whether the offending fibroids can be shrunk via hormone therapy in place of or in addition to surgical intervention.   To prepare for the surgery, the patient may be asked to fast in the hours before the procedure. Patients should also be sure to let their doctor(s) know about any medications and/or dietary supplements that they’re taking.   

How it is performed

There are three different myomectomy methods that are commonly done depending on the size, number, and location of the fibroids as well as the preference and experience of the surgeon. Each procedure is performed with the patient under either general or spinal anesthesia. 

Laparotomy/Abdominal myomectomy: The surgeon will make a large, open incision in the abdomen to access the uterine wall and removes fibroids through the incision. This procedure is often done to remove larger fibroids or fibroids that are deep within the uterus.

Laparoscopic myomectomy:  A procedure in which the uterus is visualized using a viewing instrument.  Small incisions are made in the abdomen and the viewing instrument is then inserted to assist in viewing the fibroids.  This method is often used to remove only a few fibroids that may be growing outside of the uterus.

Hysteroscopic myomectomy: This procedure involves inserting a viewing instrument into the vagina to access the uterus. This instrument also has the ability to cut the offending tissue, which is subsequently washed out with a sterile saline solution.

In each case, the incisions are all sutured following the removal of the fibroids.

Recovery

After the procedure the patient is kept under observation for some time and recovery time vary depending on the specific method of myomectomy the patient underwent. Laparoscopy and hysteroscopy require very little time in the hospital and are even often considered outpatient procedures. A laparotomy requires about one to four days in the hospital. As for recovery time, patients should expect to spend around 2 weeks of recovery time for both a hysteroscopy and a laparoscopy and around 6 weeks for a laparotomy.  Patients should receive pain medication to manage discomfort and they are often instructed to restrict activities and undergo a different diet for a while.

Potential Risks

As with other invasive surgical procedures, there are certain common risks involved with any myomectomy procedure. These include: Infection, excessive bleeding, occurrence of scar tissue, possible injuries to the bladder or bowels.

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