What is a Myomectomy?
Myomectomy is a surgical technique that removes fibroids (benign growths) from your uterus. Uterine fibroids affect over 20% of women who are of reproductive-age. In some cases, no symptoms of the problem are manifested. In other cases, symptoms can range from mild to severe menstrual bleeding, pelvic pain, and urinary problems, amongst others. Less common problems include bowel problems, anaemia, and infertility. For more information on the symptoms, types, and causes of the condition, please visit our page on Uterine Fibroids.
When is a Myomectomy Performed?
A myomectomy may be recommended to you under several circumstances. Some of these include:
- The prolonged and heavy bleeding caused by fibroids in the uterus can cause some women to become anaemic.
- Relief from pain or pressure. In some cases, the medicines prescribed may fail to mitigate the pain and pressure caused by uterine fibroids.
- Infertility Sometimes uterine fibroids may interfere with a woman’s ability to conceive or carry a baby to term. Since a myomectomy leaves the uterus intact, it is the preferred treatment of choice for women who wish to conceive in the future. Under certain circumstances, the procedure may even improve a woman’s chances of conceiving.
How is a Myomectomy Performed?
There are three different types of myomectomy. The method selected for each case depends upon factors like the location, size, and number of fibroids in the uterus. Mostly Dr G prefers a laparoscopic approach (keyhole surgery).
- Hysteroscopy: A hysteroscopic myomectomy involves the usage of a hysteroscope—a thin device with a mini-camera affixed at one end. The hysteroscope is passed into your uterus through the vagina, and will allow Dr G to examine your uterine lining on an external, large screen. He will then introduce an instrument through the scope to be able to resect the fibroids. This procedure is ideal for fibroids that haven’t grown into the uterine wall.
- Laparoscopy: A laparoscopic myomectomy is a minimally invasive surgical procedure that involves the usage of a laparoscope — a fibre-optic instrument with a mini-camera at one end. Unlike the hysteroscope, which is passed through the vaginal opening, a laparoscope is passed through a tiny incision made on your abdomen. After injecting carbon dioxide into your abdominal cavity to improve visual clarity and increase his workspace (a process known as insufflation), Dr G will locate your fibroids. He then makes an incision on the uterus before the fibroids are removed. The uterine incision is then sutured to protect the integrity of the uterus and to stop the bleeding. Dr G may use a special instrument to help him to remove the fibroids laparoscopically. Laparoscopic surgery is normally done as an overnight procedure. It gives you a fast recovery with minimal pain.
- Laparotomy: A laparotomy involves the surgical removal of uterine fibroids. The surgery is performed through a large abdominal incision. Dr G only recommends this option for women with very large, deep-growing or numerous fibroids or which may be suspicious of cancerous fibroids.
Complications of a Myomectomy
Potential complications that may arise from a myomectomy include:
- Infection of the fallopian tubes, ovaries, or uterus
- Formation of scar tissue (which, in rare cases, may lead to infertility)
- Bladder or bowel damage
- Bowel adhesions
- Uterine scars that rupture late in one’s pregnancy or during labour
- Placental problems that might necessitate a caesarean delivery
Most of these risks are rare, however. You may discuss any concerns about the procedure with Dr G.
Before a Myomectomy
Before your myomectomy, Dr G will ask you about the medication you’re on (if any). While most medicines can continue to be taken, a few may not be safe. Dr G may also require you to undergo bowel preparation before the procedure. This would necessitate being on a liquid diet for the 24 hours that precede your myomectomy surgery. If you are a smoker, you should abstain from smoking as well.
After a Myomectomy
Your recovery time can vary depending upon the surgical method used and your current state of health. Usually, women who undergo a hysteroscopy are discharged on the same day. Recovery can take anything from a few days to two weeks. A laparoscopy is performed under general anaesthesia. You may either be discharged on the same day or the next. Recovery after a laparoscopy usually occurs within one to two weeks. A laparotomy may require a hospital stay of up to four days. Recovery can take between four to six weeks.
While you may eat, drink, move, and bathe as normal, you should avoid lifting heavy objects and exercising after your myomectomy surgery. Pain, discomfort, or fatigue after a laparoscopy is normal and to be expected. If these problems don’t disappear within a few days or worsen, you should contact Dr G. Seek medical help immediately if you experience any of the problems below:
- Heavy vaginal bleeding
- Foul vaginal discharge
- Severe nausea and/or vomiting
- Problems with urination and defecation
- Severe pain
Since fibroids can grow back, women who wish to conceive are recommended to do so as soon as is safe after their myomectomy (definitely not within the first three months). If you are considering infertility treatments, Dr G may recommend a special ultrasound that examines your fallopian tubes and uterus.